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Form  L.-9-15m-8,'26 

MANUAL 


OF 


MILITARY  HYGIENE 


FOR 


THE  MILITARY  SERVICES  OF  THE 
UNITED  STATES 

BY 

VALERY  HAVARD,  M.  D. 

COLONEL,    MEDICAL   CORPS,   UNITED   STATES   ARMY,   RETIRED; 
FORMER  PRESIDENT,   ARMY   MEDICAL  SCHOOL 


PUBLISHED  UNDER  THE  AUTHORITY  AND  WITH  THE  APPROVAL  OF 
THE  SURGEON  GENERAL  U.  S.  ARMY 


THIRD,  REVISED  EDITION 


Illustrated  with  Seven  Plates  and 
Two  Hundred  and  Forty-five  Engravings 


NEW    YORK 

WILLIAM  WOOD  AND  COMPANY 

MDCCCCXVII 


COPYRIGHT,  1917 
BY  WILLIAM  WOOD  &  COMPANY 


Printed  by 

Hamilton  Printing  Company 
Albany,  N.   Y. 


PREFACE  TO  THE  THIRD  EDITION 


The  second  edition  of  this  work  having  been  exhausted  shortly 
after  our  country  became  involved  in  the  present  European  war, 
and  a  third  edition  called  for  with  as  little  delay  as  possible,  advan- 
tage was  taken  of  the  very  limited  time  allowed  the  author  for  such 
revision  and  addition  as  seemed  most  desirable.  No  material 
changes  have  been  made  and,  it  is  believed,  none  were  necessary. 

The  aim  of  the  author,  in  preparing  this  edition,  has  been  thiefly 
to  present  the  sanitary  devices  and  methods  evolved,  as  well  as  the 
result  of  the  more  important  investigations  pursued,  in  military 
hygiene,  during  the  last  two  or  three  years,  so  as  to  bring  it  as 
nearly  up  to  date  as  stress  of  time  and  occupation  would  permit. 
The  prominent  hygienic  features  of  the  Great  War  now  being  waged 
have  not  been  overlooked  and  are  duly  noted.  Some  of  the  sub- 
jects, already  obsolescent,  have  been  omitted  or  shortened  so  that 
the  number  of  pages  is  but  slightly  increased. 

It  is  hoped  this  new  edition  will  prove  worthy  of  the  compliment- 
ary reception  accorded  its  predecessors,  and  commend  itself  to  the 
favorable  consideration  of  all  medical  officers. 

VALERY  HAVARD. 

FAIRFIELD,  CONN.,  August,  1917. 


PREFACE  TO  THE  FIRST  EDITION 


The  aim  of  this  Manual  is  to  present  in  a  clear  and  concise  man- 
ner the  art  and  science  of  military  hygiene  in  its  latest  advances, 
especially  as  evolved  in  this  country  during  the  last  few  years. 

While  believing  that  there  is  a  real  need  for  such  a  book  at  this 
time,  the  writer  fully  recognizes  the  gret  amerits  of  the  works  on 
military  hygiene  already  published  in  this  country  and  which  have  so 
much  contributed  to  our  progress.  To  them  all,  but  especially  to 
the  classic  work  of  Munson,  he  acknowledges  his  great  indebtedness. 

Within  the  limited  compass  of  this  Manual,  it  was  not  deemed 
desirable  to  include  many  subjects  more  or  less  connected  with 
hygiene,  but  pertaining,  more  particularly,  to  physiology,  chemistry 
and  bacteriology,  and  fully  treated  in  special  text-books. 

Although  primarily  intended  for  medical  officers  the  hope  is  enter- 
tained that  it  will  also  be  found  useful  and  acceptable  by  all  line  and 
staff  officers  in  command  of  troops,  as  well  as  by  the  student  officers 
of  our  service  schools.  To  that  end,  all  unnecessary  technical 
expressions  have  bee  navoided,  but  without  any  sacrifice  of  scientific 
accuracy. 

In  order  to  elucidate  important  subjects  and  render  long  descrip- 
tions needless,  as  many  illustrations  as  was  possible  have  been  used, 
with  the  trust  that  they  will  greatly  add  to  the  practical  value  of 
the  book. 

To  Dr.  W.  M.  Gray,  of  the  Army  Medical  Museum,  my  acknowl- 
edgments are  due  for  the  photographic  work  of  the  plates  and 

engravings. 

VALERY  HAVARD. 
WASHINGTON,  D.  C,  February,  1909. 


TABLE  OF  CONTENTS 


INTRODUCTION XV 

Nature,  object  and  scope  of  hygiene.  What  it  has  already 
accomplished.  The  medical  officer;  his  status,  duties  and 
responsibilities.  Conditions  necessary  for  the  successful  opera- 
tion of  military  hygiene. 

CHAPTER   I. 

MORBIDITY  AND  MORTALITY  IN  THE  MILITARY  SERVICE I 

Morbidity  and  mortality  in  time  of  peace.  Morbidity  and 
mortality  in  war.  Character  of  wounds  in  the  present  Euro- 
pean War.  Morbidity  and  mortality  in  tropical  countries. 
Influence  of  race.  Influence  of  age  and  length  of  service. 
Influence  of  climate  and  station. 

CHAPTER   II. 

DISEASES  OF  THE  SOLDIER 23 

Infectious  diseases.     Typhoid  fever.     Paratyphoid  fever. 

CHAPTER   III. 

INFECTIOUS  DISEASES  (CONTINUED) 44 

Diarrhea  and  dysentery.     Sprue  (Psilosis).    Cholera. 

CHAPTER    IV. 

INFECTIOUS  DISEASES  (CONTINUED) 54 

Tuberculosis.     Pneumonia. 

CHAPTER   V. 

INFECTIOUS  DISEASES  (CONTINUED) 63 

Malaria.     Blackwater   fever.    Yellow   fever.    Dengue. 


CHAPTER   VI. 

INFECTIOUS  DISEASES  (CONTINUED) 80 

Malta   fever.     Papataci   fever.     Six-day  fever.     Typhus   fever. 
Relapsing  fever.     Rocky  Mountain  spotted  fever.     Plague. 


yiii  CONTENTS. 

CHAPTER   VII. 

INFECTIOUS  DISEASES  (CONTINUED) 90 

Cerebrospinal    meningitis.      Diphtheria.       Smallpox.       Scarlet 
fever.     Measles.     Mumps.     Influenza. 

CHAPTER   VIII. 

INFECTIOUS  DISEASES   (CONTINUED) 97 

Tetanus.       Rabies.      Anthrax.       Glanders.      Leprosy.      Yaws. 
Climatic  bubo.     Leishmaniasis.     Trypanosomiasis. 

CHAPTER    IX. 

PARASITIC  DISEASES  105 

Parasites  of  the  circulatory  and  lymphatic  systems.  Intes- 
tinal parasites.  Skin  parasites. 

CHAPTER   X. 

NUTRITIONAL  AND  MISCELLANEOUS  DISEASES 114 

Pellagra.  Beriberi.  Scurvy.  Heart  diseases.  Trench  foot. 
Asphyxiating  gases. 

CHAPTER   XI. 

DISEASES  CAUSED  BY  IMMORAL  OR  INTEMPERATE  HABITS 122 

Venereal  diseases.     Alcoholism. 

CHAPTER   XII. 

THE  TOBACCO  AND  DRUG  HABITS 133 

Tobacco.     Morphine.     Cocaine. 

CHAPTER    XIII. 

DISEASE-TRANSMITTING  ANIMALS  141 

Mites  and  ticks.  Insects  proper :  bedbug,  louse,  fleas,  cock- 
roaches, flies. 

CHAPTER   XIV. 

THE  MOSQUITO  AS  DISEASE  TRANSMITTER 159 

Description.     Classification.    Destruction. 

CHAPTER   XV. 

INSECTICIDES 178 

Pyrethrum.  Datura.  Mimm's  culicide.  Pyrofume.  Sulphur 
dioxid.  Hydrocyanic  acid.  Formaldehyde.  Mercuric  chloride. 
Liquid  insecticides. 


CONTENTS.  IX 

CHAPTER  XVI. 

RECRUITING 182 

General  considerations.  Age.  Height,  weight  and  chest 
measurement.  Vision  and  hearing.  Mode  of  examining, 
physically  and  mentally.  Special  disqualifications.  Identifica- 
tion record. 

CHAPTER   XVII. 

EXERCISE 201 

Physiology  of  exercise.  Fatigue.  Effects  of  exercise  on  all 
the  organs  of  the  body. 

CHAPTER  XVIII. 

EXERCISE  (CONTINUED)   218 

Regulation  of  exercise.  Overtraining.  Gymnastics  and  physi- 
cal training.  Special  exercises.  Athletic  games  and  races. 


CHAPTER   XIX. 

THE  MARCH   233 

General  considerations.     Regulation.     Care  of   feet.     Irritable 
heart.     Work  done  in  marching. 


CHAPTER   XX. 

PERSONAL  HYGIENE 246 

Daily    toilet.     Baths.    Laundering.     Care    of   bowels. 


CHAPTER   XXI. 

WATER 257 

Quantity  required.    Water  in  nature.    Wells.    Examination  of : 
chemical,  miscroscopic  and  bacteriological. 


CHAPTER   XXII. 

WATER  PURIFICATION  273 

By  heat.     By  chemical  means.     The  water  bag  sterilizer. 


CHAPTER  XXIII. 

WATER  PURIFICATION  (CONTINUED) 290 

Filtration.      Domestic    filters.       Sand    filtration.      Mechanical 
filtration.     The  Darnall  filter.     Improvised  filters. 


X  CONTENTS. 

CHAPTER   XXIV. 

FOOD 30? 

Classification.     Proximate  principles  and  their  nutritive  func- 
tions. 

CHAPTER   XXV. 

ANIMAL  FOODS   3 18 

Meat.     Characteristics  of  good  meat.     Meat  parasites.     Meat 
poisoning.     Cooking.     Broth  and  extracts.     Preservation. 

CHAPTER   XXVI. 

ANIMAL  FOODS  (CONTINUED) 337 

Fish.     Mollusks.     Crustaceans.     Milk.     Eggs. 

CHAPTER   XXVII. 

VEGETABLE  FOODS  349 

Classification.     Composition.      Description.     Flour   and   bread. 

CHAPTER   XXVIII. 

THE   NUTRITIVE  VALUE   OF   FOODS 363 

Amount  necessary.     Chittenden's  experiments. 

CHAPTER   XXIX. 

FIELD  COOKING  AND  BAKING 371 

Field  range.     Fireless  cooker.     Baking  ovens.     Field  cooking 
in  foreign  armies. 

CHAPTER   XXX. 

THE  RATION   383 

U.  S.  Army  ration ;  its  several  kinds.     Composition  and  value . 
Navy  ration.     Ration  in   foreign  armies. 

CHAPTER   XXXI. 

CONCLUSIONS  REGARDING  THE  COMPOSITION  AND  FOOD  VALUE  OF  THE  MILI- 
TARY RATION   396 

CHAPTER   XXXII. 

THE  RATION   IN   THE  TROPICS 4OO 

CHAPTER  XXXIII. 

RULES   TO  BE  OBSERVED  IN   EATING  AND  DRINKING 406 


CONTENTS.  XI 

CHAPTER   XXXIV. 

BEVERAGES 409 

Non-alcoholic.     Alcoholic. 

CHAPTER   XXXV. 

CLOTHING  AND  UNIFORM 419 

Properties  of  textile  fabrics.  Underclothing.  Xon-actinic 
colors.  The  uniform.  Coats.  Trousers.  Head-gear.  Gloves. 

CHAPTER   XXXVI. 

UNIFORM  (CONTINUED)    441 

Foot-wear.     Requisites  of  the  military  shoe.     Leggins. 

CHAPTER   XXXVII. 

EQUIPMENT 453    ' 

Requirements.  Distribution  of  weight.  Knapsack.  Equipment 
in  foreign  armies.  Equipment  in  U.  S.  Army. 

CHAPTER   XXXVIII. 

POSTS,   BARRACKS   AND  QUARTERS 473 

General  considerations.  Construction  and  materials.  U.  S. 
barracks.  Furniture  and  bedding. 

CHAPTER   XXXIX. 

POSTS,    BARRACKS    AND    QUARTERS    (CONTINUED) 4Q2 

Care  of  barracks  and  guard-house.  Insects  and  vermin.  Care 
of  kitchen  and  mess-room. 

CHAPTER  XL. 

MILITARY  HOSPITALS 498 

Post  hospitals.     General  hospitals.     Base  hospitals. 

CHAPTER   XLI. 

AIR 509 

Composition.  Humidity.  Influence  of  ocean,  lakes  and  for- 
ests. Effects  of  altitude.  Atmospseric  dust. 

CHAPTER   XLII. 

VENTILATION 519 

Air  contamination.  Overheating.  High  humidity.  Air  stag- 
nation. Tests  for  carbon  dioxid  and  carbon  monoxid.  Nature 
<~>f  ventilation.  Amount  of  air  necessary. 


Xli  CONTENTS. 

CHAPTER   XLIII. 

VENTILATION   (CONTINUED)    534 

Natural   ventilation.     Artificial   ventilation.     Draft. 

CHAPTER   XLIV. 

HEATING 544 

Heat  transmission.  Suitable  indoor  temperature.  Open  fire. 
Stove.  Hot-air  furnace.  Hot  water.  Steam.  Heat  and  air 
dust. 

CHAPTER   XLV. 

LIGHTING 557 

Effects  of  light.     Location  of  lights.     Illuminants  used. 

CHAPTER   XLVI. 

EXCRETA,  GARBAGE  AND  WASTES 564 

Definition.  Sewerage  and  plumbing.  Fixtures  and  pipes. 
Traps.  Water-closets.  Urinals.  Hygiene  of  toilet  rooms. 
Sewers. 

CHAPTER   XLVII. 

EXCRETA,  GARBAGE  AND  WASTES  (CONTINUED) 578 

Nature  of  sewage.  Final  disposal.  Discharge  into  the  sea,  a 
lake  or  river.  Chemical  treatment.  Irrigation.  Septic  tank. 
Imhoff  tank.  Filtration.  Contact  filter.  Sprinkling  filter. 
Disinfection  of  affluent.  Disposal  in  garrison  and  camp.  Sub- 
surface irrigation.  Disposal  of  garbage. 

CHAPTER  XLVIII. 
SOIL 597 

Properties.  Ground  air.  Ground  moisture.  Ground  tempera- 
ture. Influence  of  vegetation.  Soil  bacteria. 

CHAPTER   XLIX. 
CAMPS 603 

Selection  of   site.     Poisonous  plants.     Venomous  animals. 

CHAPTER  L. 

CAMPS  (CONTINUED)    614 

Tents;  advantages  and  objections.  Shelter  tent.  Wall  tent. 
Conical  tent.  Pyramidal  tent.  Hospital  tent.  Hospital  ward 
tent.  Tortoise  tent. 


CONTENTS.  Kill 

CHAPTER   LI. 

CAMPS  (CONTINUED)    624 

Improvised  and  portable  barracks.  Log  hut.  Falk's  method. 
Dugouts.  Knock-down  pavilions.  Form  of  camp.  Field 
hospital.  Establishment  of  camp. 

CHAPTER   LII. 

LATRINES 636 

Trenches.  Pits  or  sinks.  Latrine  box.  Post  holes.  Sanitary 
trough  latrine.  Earth-closet  latrine.  Knock-down  sheds. 

CHAPTER   LIII. 

DISPOSAL  OF  EXCRETA  BY  INCINERATION 658 

The  McCall  incinerator.  The  Harris  incinerator.  The  Q.  M. 
C.  incinerator.  The  Conley  incinerator. 

CHAPTER   LIV. 

LAVATORY.    DISPOSAL  OF  WASTES,  GARBAGE  AND  REFUSE  IN  CAMP 666 

Kitchen  pit.  Company  incinerator.  Caldwell  incinerator. 
Guthrie  incinerator.  Rock  pile  crematory.  Disposal  of  manure. 

CHAPTER   LV. 
GENERAL  SANITARY  RULES  IN  THE  FIELD 677 

CHAPTER   LVI. 
ADMINISTRATION  OF  THE  SANITARY  SERVICE  IN  THE  FIELD 683 

CHAPTER   LVI  I. 

SERVICE  IN  WARM  CLIMATES 686 

Characteristics  of  tropical  climates.  Its  effects  upon  the  body. 
Food.  Beverages.  Solar  rays.  Actinic  rays.  Sunstroke. 
Clothing.  Shelter.  General  directions.  Tropical  diseases. 

CHAPTER   LVIII. 
SERVICE  IN  COLD  CLIMATES 712 

CHAPTER  LIX. 

DISINFECTION  AND  DISINFECTANTS 719 

Air  and  light.  Heat.  Steam.  Sulphur  dioxid.  Formaldehyde ; 
methods  of  generation  and  use.  Disinfectants  in  solution. 
Lime.  Room  disinfection.  Treatment  of  hands,  feces  and 
sputum. 


xiv  CONTENTS. 

CHAPTER    LX. 
HYGIENE  OF  THE  BATTLEFIELD  ...........................................  744 

Precautions  to  be  observed.  Sanitary  features  of  modern  war- 
fare. Trench  hygiene.  Disposal  of  the  dead. 

CHAPTER   LXI. 
NAVAL  AND  MARINE  HYGIENE  ...........................................  752 

Effects  of  life  aboard  on  health.  Recruiting.  Ventilation. 
Heat  and  humidity.  Personal  hygiene.  Disinfection  of  ships. 
The  sick  bay.  Hospital  ship. 

CHAPTER   LXII. 
QUARANTINE   ..........................................................  774 

Quarantinable  diseases.  Special  U.  S.  regulations  for  each. 
Interstate  quarantine.  Municipal  quarantine.  Articles  of  the 
second  international  sanitary  convention  of  American  republics 


BIBLIOGRAPHY  ........................................................  787 

INDEX  ...............................................................  795 


INTRODUCTION 


Hygiene  is  the  science  of  preserving  and  promoting  health.  It 
seeks  out  and  determines  the  causes  of  disease  and  formulates  rules 
for  their  prevention  and  removal.  It  may  then  also  be  defined  the 
science  of  preventing  disease.  No  science  can  be  more  important 
or  beneficial  to  humanity  so  long  as  we  consider  health  the  most 
precious  of  all  our  earthly  blessings.  Prevention  is  better  than  cure ; 
therefore,  to  the  world  at  large,  hygiene  is  of  more  value  than 
medicine. 

But  the  two  sciences  are  so  inextricably  blended  and  mutually 
beneficial  that  it  would  be  futile  to  attempt  to  differentiate  them. 
Hygienists,  to  be  successful,  must  possess  a  well-grounded  knowl- 
edge of  medicine,  while  physicians  must  avail  themselves  of  the 
researches  and  discoveries  of  hygienists  if  they  wish  to  do  justice 
to  their  patients. 

Hygiene  is  usually  described  as  individual  and  public.  Under 
individual  or  personal  hygiene  are  grouped  the  subjects  of  body 
cleanliness,  diet,  exercise  and  habits,  while  public  hygiene  considers 
all  those  measures  which,  under  the  name  of  sanitation,  are  insti- 
tuted for  the  welfare  of  communities,  such  as  water-supply, 
disinfection,  sewerage  and  disposal  of  wastes.  Sanitation  deals  with 
the  removal  of  all  conditions  favoring  the  growth  and  propagation 
of  pathogenic,  or  disease-bearing,  germs ;  to  it  may  be  ascribed  the 
chief  share  in  the  beneficient  effect  of  hygiene  in  saving  human  lives 
and  extending  longevity. 

All  diseases  may  be  classed  under  two  heads:  I,  those  arising 
within  the  body  (autogenetic  diseases),  due  to  disturbances  of 
nutrition,  assimilation  and  elimination,  the  result  of  a  want  of 
harmony  between  waste  and  repair,  such  as  rheumatism,  gout, 
diabetes,  arterio-sclerosis,  tumors,  nervous  diseases,  etc. ;  2,  those 
due  to  causes  from  without  and  depending  upon  the  invasion  and 
multiplication  of  special  germs  in  the  body,  such  as  the  infectious 
or  zymotic  diseases. 

Hygiene  is  concerned  in  the  prevention  of  both  classes.  By  deter- 
mining the  relations  which  should  exist  between  diet,  work  and 


XVI  INTRODUCTION. 

exercise,  it  secures  a  sufficient  assimilation  of  suitable  food  and  a 
free  eliminaton  of  wastes,  without  overstrain  of  any  of  the  organs ; 
thus  are  the  diseases  of  the  first  class  guarded  against.  However, 
it  is  especially  in  preventing  those  of  the  second  class,  among  which 
are  the  so-called  camp  diseases,  that  military  hygiene  is  most 
efficacious. 

For  the  production  of  infectious  diseases  two  factors  are  neces- 
sary :  the  germs  must  be  absorbed  in  the  body  through  the  digestive 
or  respiratory  tracts,  or  by  inoculation  through  the  skin ;  and,  being 
absorbed,  they  must  find  a  suitable  soil  in  which  to  grow  and  breed, 
that  is  to  say,  the  body  must  be  in  a  susceptible  or  receptive  state. 
The  hygienist,  therefore,  should  have  a  sufficient  knowledge  of 
bacteriology,  but  the  description  and  reactions  of  the  pathogenic 
micro-organisms  are  of  less  consequence  to  him  than  their  mode  of 
transmission  and  introduction  into  the  human  body.  Thus  we 
know  how  yellow  fever  is  conveyed,  and  this  knowledge  has  enabled 
us  to  stamp  it  out  from  Cuba  and  other  places,  although  the  causal 
micro-organism  has  never  been  seen.  On  the  other  hand,  we  know 
the  bacillus  of  leprosy,  but  on  account  of  our  ignorance  of  the 
manner  in  which  it  effects  an  entrance  into  the  body,  under  natural 
conditions,  very  little  has  as  yet  been  accomplished  for  the  preven- 
tion of  that  terrible  disease. 

As  a  country  develops  its  material  resources  under  the  favorable 
conditions  of  peace  and  acquires  wealth,  its  hygiene,  as  a  rule, 
progresses  correspondingly ;  the  people  eat  better  food,  are  better 
clothed  and  sheltered  and  make  more  frequent  use  of  the  bath, 
while  the  cities  and  State  construct  public  works  of  sanitation.  The 
result  has  been  a  remarkable  fall  in  the  death  rate  of  all  civilized 
countries  during  the  past  quarter  of  a  century,  as  shown  by  the 
following  figures  from  the  reports  of  the  Census  Office : 

In  the  United  Kingdom  (England,  Scotland  and  Ireland)  the 
yearly  mortality  per  1,000  inhabitants,  which  was  about  22  in  1870, 
has  diminished  steadily  until  the  present  time,  being  18.2  in  1900 
and  15.5  in  1905.  This  means  that,  since  1870,  for  each  1,000  in- 
habitants there  is  a  saving  of  6.5  lives,  or,  for  a  population  of 
40,000,000,  of  260,000  lives  a  year.  In  England  and  Wales,  the 
rate  for  1910  was  only  13.5  and  for  1913,  13.7. 

In  France  the  mortality  fell  from  26  in  1820  to  21.5  in  1900, 
19.6  in  1905  and  17.7  in  1913;  in 'Germany,  from  26.8  in  1850  to 


INTRODUCTION.  Xvil 

22.2  in  1900,  19.9  in  1905  and  15.6  in  1912;  in  Austria,  from  32.2  in 
1850  to  29.5  in  1890,  26.6  in  1900,  24.1  in  1905  and  20.5  in  1912; 
in  Italy,  from  27.1  in  1890  to  24.2  in  1900,  21.8  in  1905  and  18.2  in 
1912;  in  Spain,  from  30  in  1900  to  26.1  in  1905  and  21.8  in  1912. 

In  the  United  States  the  death  rate  for  the  registration  area  was 
19.6  in  1890,  17.8  in  1900,  16.2  in  1905,  15.0  in  1910,  and  13.6  in 
1914.  The  registration  area  (consisting  of  67  per  cent,  of  total 
population  in  1914)  includes  most  of  the  large  cities,  where  the  death 
rate  is  higher  than  in  rural  districts.  Thus  the  rate  for  the  rural 
part  of  the  registration  States  in  1914  was  only  12.3.  As  the  non- 
registration States  include  a  much  larger  rural  part  than  the  registra- 
tion area,  it  is  reasonable  to  conclude  that  for  the  total  population  the 
death  rate  for  1914  is  well  under  13.  If,  furthermore,  we  take 
into  account  the  fact  that  the  colored  people,  which  form  such  an 
important  element  of  our  population,  have  a  mortality  at  least  60 
per  cent,  greater  than  that  of  the  whites,  it  follows  that  the  death 
rate  of  the  white  population  of  the  United  States,  considered  by 
itself,  must  be  among  the  lowest  in  the  world. 

The  decrease  of  mortality  in  some  of  our  principal  cities  has  been 
as  follows : 

New  York  ....  20.4  in  1900,  16.0  in  1910,  13.9  in  1914. 

Philadelphia      .     .     .  21.2  in  1900,  i6.8ini9io,  15.9^11914. 

Chicago 1 6.2  in  1900,  15.1  in  1910,  13.9^1914. 

Boston     .....  20.1  in  1900,  17.2  in  1910,  14.3  in  1914. 

Baltimore     .     .    -.    .  21.    in  1900,  19.2  in  1910,  17.3  in  1914. 

St.  Louis     ....  17.9^11900,  15.8  in  1910,  14.6^1914. 

New  Orleans    .     .     .  22.3  in  1902,  21.3  in  1910,  18.5  in  1914. 

The  progress  of  military  hygiene  has  fully  kept  pace  with  that  of 
general  hygiene.  The  death  rate  in  our  Army  was  about  15  in 
1870,  ii  in  1880,  and  had  gradually  fallen  to  5.11  in  1897,  before 
the  Spanish  War.  As  the  result  of  this  war,  of  the  subsequent 
insurrections  in  the  Philippine  Islands  and  of  the  unusual  and 
ardous  conditions  of  tropical  service,  the  mortality  remained  for 
several  years  above  its  normal  rate,  but  is  again  steadily  lowering, 
being  5.81  in  1907,  4.46  in  1910,  4.40  in  1914  and  4.45  in  1915,  for 
the  whole  Army  at  home  and  abroad. 

The  same  improvement  is  noted  in  all  European  armies.  Thus  in 
the  British  Army  the  death  rate  for  troops  at  home  was  7.20  for 


XV111  INTRODUCTION. 

the  decade  1875-84  and  4.68  for  the  decade  1887-96,  rising  to  5.61 
in  1905  and  falling  to  2.92  in  1909  and  2.34  in  1912.  In  the  Prus- 
sian Army  the  rate  fell  from  4.82  in  1880  to  3.30  in  1890,  1.80  in 
1907  and  2.0  in  1911  '  and  in  the  French  Army,  from  about  8  in 
1880  to  5.81  in  1890,  3.92  in  1907  and  3.01  in  1910. 

Military  hygiene  differs  from  general  hygiene  only  in  its  appli- 
cation ;  its  laws  and  principles  are  necessarily  the  same.  The  soldier 
is  subject  to  the  same  diseases  as  the  civilian,  but  in  a  different 
degree  on  account  of  the  special  conditions  under  which  he  lives. 
He  is  to  a  large  extent  bereft  of  his  personal  freedom ;  his  food  and 
shelter  are  provided  for  him,  while  his  work  and  exercise  are 
strictly  regulated.  In  war  time,  his  food  and  surroundings  are 
those  which  military  necessity  imposes,  the  preservation  of  his 
health  becoming  a  matter  of  secondary  consideration.  The  crowd- 
ing of  troops  in  barracks  or  camps  facilitates  the  transmission  of 
disease  and  is  an  element  of  danger  much  more  serious  than  in  civil 
life,  but,  on  the  other  hand,  in  a  well-administered  army  the  soldier 
is  the  object  of  sanitary  measures  which,  if  properly  enforced  will, 
to  a  large  extent,  safeguard  him  against  the  dissemination  of  infec- 
tious germs. 

The  vital  importance  of  hygiene,  in  garrison  and  the  field,  has 
been  more  fully  realized  of  late  years,  especially  since  the  Spanish- 
American  War.  The  investigations  carried  on  during  and  after  this 
war  have  shown  that  the  diseases  which  caused  its  terrible 
mortality  were  mostly  preventable,  that  they  resulted  from  the  lack 
of  efficient  sanitary  measures  or  their  indifferent  application.  It  is 
the  earnest  belief  of  the  Medical  Corps  that  such  unnecessary  sacri- 
fice of  life  cannot  again  occur  in  our  Army,  except  through  unpar- 
donable ignorance  or  criminal  carelessness. 

It  is  now  recognized  that  the  sanitary  service  of  an  army  is  not 
an  impedimentum  or  a  necessary  evil  to  be  tolerated,  but  that,  on 
the  contrary,  it  is  an  essential  and  integral  part  of  its  organization, 
materially  contributing  to  its  fighting  efficiency  by  preventing  the 
depletion,  from  disease,  of  the  combatants'  ranks,  and  by  such  treat- 
ment of  the  sick  and  wounded  as  will  permit  their  prompt  return  to 
the  firing  line. 

On  this  subject,  Field  Marshal  Evelyn  Wood,  of  the  British 
Army,  expresses  himself  as  follows :  "  I  am  convinced  from  my 
experience  of  thirty  years  as  a  general  that  the  army  doctors  should 


INTRODUCTION.  XIX 

be  regarded  not  merely  as  healers  of  the  sick  and  wounded,  but 
as  trusted  staff  officers  to  advise  their  chiefs  how  to  guard  the 
troops  against  the  originating  and  spreading  of  disease  and  thus 
maintain  the  number  of  effectives  in  a  campaign.  This  will  result 
not  only  in  the  increasing  of  fire  effect,  but  will  raise  immensely 
the  fighting  value  of  the  troops  and  will  incidentally  enable  us  to 
reduce  the  costly  and  cumbersome  hospital  establishment  and 
transport." 

Hygienic  measures  are  expensive,  but  they  will  prove  compara- 
tively cheap  if  they  prevent  disease,  for  nothing  is  more  costly  than 
a  sick  soldier ;  not  only  is  he  useless  in  war  but  requires  the  services 
of  able-bodied  comrades,  and  later  burdens  the  pension  list.  A 
trained  soldier  is  a  valuable  product  as  an  efficient  fighting  machine ; 
the  chief  duty  of  the  medical  officer  is  to  maintain  him  in  his  best 
physical  condition  and,  in  case  of  sickness  or  wound,  to  return 
him  to  the  ranks  in  the  shortest  possible  time. 

With  a  fuller  appreciation  of  the  importance  of  hygiene  has  come, 
as  a  natural  consequence,  a  remarkable  change  in  the  functions  and 
duties  of  medical  officers.  Formerly  they  were  primarily  surgeons 
and  so  designated  in  official  parlance,  but  now  they  are  chiefly  sani- 
tarians ;  their  principal  work  is  no  longer  the  treatment  of  the 
wounded,  important  as  that  is,  but  the  prophylaxis  of  disease.  If 
camp  diseases  can  be  controlled  and  prevented,  it  is  evident  that, 
during  a  campaign,  good  sanitation  will  save  more  lives  than  the 
most  perfect  surgery ;  therefore  it  follows  that  most  medical  officers 
must  be  good  sanitarians  at  all  times,  while  only  comparatively  few 
need  be  skilled  surgeons.  The  unfitness  of  the  title  of  "  surgeons  " 
applied  to  them  is  especially  obvious  when  we  reflect  that  war  is  an 
unusual  condition,  that  modern  armies  live  generally  in  a  state  of 
peace,  when  wounds  only  result  from  accident  and  are  comparatively 
rare,  and  that  the  duties  of  medical  officers  are  chiefly  those  of 
physicians  and  sanitarians. 

The  sphere  of  activity  of  the  medical  officer  is  becoming  so  ex- 
tended and  comprehensive  that  the  question  of  specializing  his  duties 
is  now  demanding  consideration.  The  need  is  becoming  more  and 
more  felt  in  the  Army  for  experts,  not  only  in  surgery  and  special 
diseases,  and  in  general  hygiene,  but  also  in  sanitary  engineering, 
men  capable  of  installing  and  directing  water-supply  and  sewer 
systems,  filtering  and  disinfecting  plants,  etc. 


XX  INTRODUCTION. 

The  wonderfully  low  ratio  of  mortality  from  disease  during  the 
Russo-Japanese  War  had  the  result  of  compelling  attention  to  the 
organization  of  the  medical  department  of  both  belligerents ;  this, 
although  far  from  perfect,  was  seen  to  be  much  more  complete  and 
on  a  more  liberal  scale  than  had  ever  been  the  case  in  any  previous 
war  of  great  magnitude.  The  effect,  in  all  civilized  countries,  was 
the  accentuation  of  the  importance  of  military  hygiene  in  war  and 
an  increased  interest  in  its  study  and  development. 

As  the  happy  culmination  of  the  application  of  modern  preventive 
medicine  to  the  conditions  of  armies  in  the  field,  we  are  now  amazed 
to  see  the  greatest  war  that  was  ever  waged  (1917)  nearly  abso- 
lutely free  from  any  of  the  dreadful  camo  diseases  so  prevalent 
in  former  wars. 

In  our  service,  garrison  and  comp  sanitation  is  now  recognized  as 
specialized  knowledge  requiring  the  direction  of  experts  ;  therefore 
no  part  of  it  is  any  longer  intrusted  to  non-professional  officers, 
however  intelligent  and  zealous  they  may  be,  but  only  to  such 
medical  officers  who  have  acquired  this  expert  knowledge.  To  them 
should  be  turned  over  the  entire  work  of  sanitation,  initiation  and 
execution.  .For  that  purpose,  increased  authority  has  been  given 
them  and  a  correspondingly  greater  responsibility  laid  upon  them. 

It  is  obvious  that  such  authority  and  responsibility  must  have 
limitations ;  in  this  respect,  the  position  of  medical  officers  is  very 
different  from  that  of  civilian  health  officers  whose  work  is  exclu- 
sively of  a  professional  character  and  whose  will  is  supreme  as 
regards  the  manner  of  executing  it.  In  war,  conditions  are  often 
encountered  when  the  demands  of  hygiene  must  be  more  or  less 
sacrified  to  military  exigencies.  An  Army  is  organized  for  a  definite 
purpose,  which  is  war,  and  all  its  elements  must  be  shaped  and 
trained  so  as  best  to  subserve  that  purpose.  The  first  duty  of  the 
medical  officer  is  to  contribute  as  much  as  possible  to  the  fighting 
efficiency  of  the  army,  bearing  in  mind  that  the  best  way  to  insure 
proper  treatment  to  the  sick  and  wounded  is  by  first  winning  the 
victory.  While  unremitting  in  the  use  of  every  available  means  to 
prevent  the  reduction,  by  disease,  of  effective  combatants,  he  will 
acquiesce  in  and  make  the  most  of  situations  where  sanitary  consid- 
erations must  be  overlooked  for  the  sake  of  possible  military  advan- 
tages. Under  such  circumstances  the  responsibility  for  the  conse- 
quences are  assumed  by  the  commanding  officer. 


INTRODUCTION.  XXI 

All  authority  must  necessarily  be  centered  in  the  commanding 
officer.  To  divide  it  would  lead  to  military  chaos ;  complete  auton- 
omy is  no  more  possible  or  desirable  in  the  medical  than  in  any  other 
staff  department.  Under  existing  regulations,  officers  of  the  Medi- 
cal Corps  cannot  exercise  command  except  in  their  own  department. 
Their  duties  concerning  sanitary  matters,  at  post  or  in  the  field, 
are  limited  to  investigation,  report  and  recommendation.  It  is  an 
admitted  fact,  however,  that  the  best  results  are  obtained  by  endow- 
ing them  with  as  much  executive  authority  as  conditions  permit,  and 
that  it  can  be  delegated  to  them  in  the  same  manner  that  authority 
is  delegated  to  adjutants  and  inspectors.  Thus  the  Field  Service 
Regulations  provide  that  sanitary  inspectors  may  be  authorized  to 
direct,  in  the  name  of  the  commanding  officer  and  within  prescribed 
limitations,  the  prompt  abolition  of  conditions  prejudicial  to  the 
health  of  troops.  This  power  was  given  to  sanitary  inspectors  dur- 
ing our  interventions  in  Cuba,  and  in  most  of  our  recent  camps  of 
instruction,  with  excellent  results.  It  is  also  given  by  some  post 
commanders  to  their  post  surgeons  (see  page  683). 

Inasmuch  as  sanitary  recommendations  may  involve  important 
work  and  large  expenditure,  it  is  obviously  necessary  that  a  medical 
officer  should  possess  not  only  professional  knowledge  but  also  good 
judgment  and  sound  common  sense.  His  recommendations  must 
be  reasonable  and  practicable,  and  made  only  after  careful  con- 
sideration of  all  factors  involved ;  their  disapproval  by  his  profes- 
sional superior  would  discredit  him  and  impair  the  usefulness  of  the 
Medical  Corps. 

The  above  considerations  show  the  wisdom  of  Congress  in  invest- 
ing medical  officers  with  military  rank  and  military  title,  so  that 
their  authority  may  be  commensurate  with  their  responsiblity.  for 
experience  has  proved  that  military  rank  is  necessary  to  confer  the 
power  and  prestige  of  authority  —  and  no  officer  from  staff  or  line, 
in  the  field,  needs  this  authority  more  than  the  medical  officer  for 
the  successful  handling-  of  the  large  personnel  under  his  command 
and  the  efficient  discharge  of  his  manifold  duties.  Although  classed 
with  non-combatant  officers,  he  is  none  the  less  exposed  to  all  the 
hazards  of  the  fire  zone.  The  statistics  of  the  Civil  War  show  that 
more  medical  officers  were  killed  in  battle  than  officers  of  all  the 
other  staff  corps  together,  and  the  same  is  true  of  the  present 
European  War. 


xxii  INTRODUCTION. 

Although  it  is  a  well-established  policy  that  all  sanitary  appliances, 
such  as  sterilizers,  niters,  incinerators,  etc.,  as  well  as  ambulances, 
must  be  under  the  direct  control  of  the  Medical  Department,  when 
in  use,  there  is  still  some  difference  of  opinion  as  to  whether  this 
department  should  not  also  manufacture  and  store  them  in  time  of 
peace  so  that  they  may  always  be  in  readiness  on  taking  the  field. 
But  whichever  way  this  is  decided,  it  is  certain  that  the  Medical 
Department  will  always  be  more  or  less  dependent  upon  the  Q.  M. 
Corps  for  much  of  its  material  and  hired  labor  and  must  therefore 
receive  its  thorough  co-operation  to  secure  the  best  results. 

In  the  event  of  war,  the  bulk  of  our  armies  would  necessarily 
consist  of  volunteer  or  drafted  forces  and  be  under  the  sanitary 
care  of  volunteer  or  reserve  medical  officers.  These  officers  may 
be  assumed  to  have  all  the  needful  qualifications  as  physicians  and 
surgeons,  but  their  knowledge  of  practical  field  sanitation  will 
always  be  a  variable  and  uncertain  quantity.  This  is  a  weak  point 
in  our  system  requiring  serious  consideration.  The  remedy,  as  al- 
ready successfully  applied  in  several  States,  consists  in  theoretical 
instruction  during  the  winter  months  under  the  supervision  of  the 
Surgeon  General  of  each  State  and  in  practical  instruction  during 
summer  encampments.  The  sanitary  work  of  the  mixed  commands 
of  regular  and  militia  troops  at  our  summer  camps  has  been  of  the 
highest  value  as  a  school  of  instruction  not  only  to  medical  officers, 
but  as  well  to  all  line  officers  and  enlisted  men.  The  use  of  sanitary 
appliances  has  been  clearly  exhibited  and  their  beneficial  effects  upon 
the  health  of  troops  demonstrated  in  such  a  manner  as  to  produce  a 
marked  impression  upon  all  concerned.  It  is  especially  by  means  of 
such  camps  that  medical  officers  will  obtain  the  practical  knowledge 
which  they  require  and  that  line  officers  will  be  made  to  understand 
the  part  which  devolves  upon  them  in  the  work  of  sanitation. 

In  the  application  of  the  precepts  of  hygiene,  the  medical  officer, 
in  spite  of  his  efforts,  can  accomplish  but  little  if  unaided.  His 
labors,  to  be  fruitful,  must  have  the  hearty  and  intelligent  co- 
operation of  staff  and  line.  Therefore  he  must  instruct,  by  word 
and  object-lesson,  and  carry  on  a  sanitary  propaganda  which  will 
reach  down  to  every  enlisted  man.  He  should  particularly  endeavor 
to  interest  the  company  officers,  for  it  is  through  them  that  the 
men  can  be  most  readily  influenced  and  the  enforcement  of  sanitary 
measures  most  easily  accomplished.  The  intelligent  soldier,  in  a 


INTRODUCTION.  XX111 

disciplined  regiment,  complies  readily  with  regulations  intended  for 
his  welfare  as  soon  as  he  understands  their  importance  to  himself 
and  the  service. 

The  War  Department  has  realized  the  great  importance  of 
hygiene  in  the  Army  by  adding  it  to  the  curriculum  of  the  Military 
Academy  and  of  all  our  service  schools,  and  it  is  most  gratifying 
to  note  how  efficiently  our  young  officers,  at  the  very  outset  of  their 
career,  apply  the  knowledge  thus  acquired,  to  the  great  advantage 
of  the  enlisted  man. 

If  we  bear  in  mind  that  the  great  majority  of  our  soldiers  remain 
but  a  short  time  in  the  Army  and  then  return  to  civil  life,  we  must 
realize  the  highly  beneficial  effect  of  this  instruction  upon  the  health 
conditions  of  the  country  at  large.  The  thousands  of  men  yearly 
discharged  carry  with  them  to  their  homes  more  or  less  practical 
knowledge  of  the  prevention  of  disease,  as  well  as  formed  sanitary 
habits,  which  must  be  useful  to  them  and  the  people  with  whom 
they  associate,  so  that  military  hygiene,  as  taught  every  soldier  in 
the  Army,  becomes  one  of  the  most  valuable  educational  agencies 
under  the  control  of  the  Government. 

Military  hygiene,  to  be  efficacious  and  successful,  must  deal  with 
able-bodied  soldiers.  The  best  possible  care  can  never  make  strong, 
resistant  and  useful  soldiers  of  immature,  undergrown  or  otherwise 
defective  youths.  In  any  army  composed  of  men  voluntarily  enlisted 
it  would  seem  that  only  physically  perfect  individuals  should  be 
accepted  and  enlisted.  But  this  is  far  from  being  the  fact.  It  is 
not  always  the  strong  and  stout  who  present  themselves  to  the 
recruiting  officer,  nor  is  it  always  possible  to  detect  chronic  or  latent 
diseases  or  a  predisposition  to  them,  while  it  also  happens  that 
examiners  are  not  as  careful  or  experienced  as  their  duties  require. 
The  result  is  that  there  is  always  a  certain  ratio  of  sickness  due  to 
pre-existing  conditions  —  for  which  the  military  service  is  not 
responsible.  Therefore,  great  care  and  diligence  are  enjoined  by 
the  War  Department  upon  all  recruiting  officers  in  order  to  reduce 
this  ratio  to  a  negligible  minimum. 

Military  hygiene  is  indissolubly  bound  up  with  discipline.  It  is 
not  enough  to  be  familiar  with  all  its  precepts,  they  must  be  fully 
and  strictly  applied,  and  this  cannot  be  done  successfully  except 
through  discipline.  Laxity  of  discipline  in  an  army  is  the  source 
of  many  evils,  not  the  least  of  which  is  its  baneful  effect  upon  the 


XXIV  INTRODUCTION. 

dissemination  of  disease.  Assuming  that  medical  officers  are  equal 
to  their  duties,  experience  shows  that  the  health  condition  of  the 
command  will  be  directly  proportional  to  its  discipline  and,  there- 
fore, that  to  preserve  the  health  of  troops  the  action  of  regimental 
and  company  officers  is  quite  as  necessary  as  that  of  medical  officers. 
This  has  been  exemplified  in  all  modern  wars,  but  especially  in  the 
Franco-German  and  the  Russo-Japanese  Wars.  The  difference  in 
the  sanitary  condition  of  the  French  and  German  Armies  in  1870 
and  1871  was  not  less  marked  than  the  difference  in  their  fighting 
efficiency.  The  Japanese  in  Manchuria  did  not  discover  any  new 
system  of  sanitation,  but  they  excelled  in  discipline,  prompt  obedi- 
ence to  orders  and  administrative  abilities,  and  this  was  not  the 
least  of  the  causes  which  reduced  their  ratio  of  sickness  to  a  mini- 
mum never  before  reached  by  any  large  army  in  the  field. 

The  successful  application  of  military  hygiene  under  the  best 
conditions  —  that  is  to  say,  by  an  efficient  medical  department  to  a 
body  of  men  carefully  chosen  and  under  strict  discipline  —  was 
strikingly  illustrated  in  the  German  Army  which,  since  the  Franco- 
Prussian  War  of  1870,  until  the  present  European  War,  always 
had  the  lowest  mortality  of  any  army  in  the  world.  The  military 
service  being  compulsory  in  Germany  and  the  number  of  conscripts 
much  larger  than  the  annual  contingent  required,  it  was  possible 
to  make  a  careful  selection  of  recruits  and  reject  all  the  physically 
imperfect.  The  strict  discipline  prevailing  in  its  army  was  also 
notorious.  Thus  was  its  remarkably  low  death  rate  readily  and 
satisfactorily  explained. 

In  the  present  war,  in  Europe,  the  very  low  mortality  from  dis- 
ease is  chiefly  due  to  our  knowledge  of  how  to  prevent  and  success- 
fully combat  typhoid  fever,  typhus,  cholera  and  dysentery. 


MILITARY  HYGIENE 


CHAPTER  I. 

MORBIDITY  AND  MORTALITY  IN  THE  MILITARY  SERVICE. 

As  late  as  the  middle  of  the  I9th  Century,  the  crowding  of 
soldiers  in  ill-ventilated  barracks  and  the  neglect  of  all  hygienic 
rules  resulted  in  the  free  dissemination  of  infectious  germs  and  in 
enormous  rates  of  disease  and  death  in  garrisons,  several  times 
higher  than  in  civil  life.  But  since  the  Crimean  War  in  Europe  and 
the  Civil  War  in  America,  with  the  progress  of  scientific  medicine, 
it  has  become  more  and  more  evident  that  most  of  the  military  mor- 
bidity and  mortality  can  be  prevented  by  giving  soldiers  sufficient 
air  space  and  the  benefit  of  intelligent  sanitary  regulations.  In  time 
of  peace,  soldiers  are  presumed  to  be  comfortably  quartered,  prop- 
erly fed  and  clothed,  subject  to  wise  hygienic  rules  and,  to  a  large 
extent,  guarded  from  excesses  and  dangerous  exposure  by  military 
discipline.  They  are,  besides,  chosen  men,  physically  sound  when 
enlisted  or  mustered  in.  Under  such  conditions  one  would  expect 
them  to  enjoy  at  least  as  good  health  as  males  of  the  same  age  in 
civil  life.  It  is  true  that  the  danger  of  conveying  disease  by  contact, 
direct  or  indirect,  in  barracks,  even  when  sufficiently  roomy,  is  ever 
present  and  cannot  be  overlooked.  The  question  is  complicated  by 
several  interacting  factors  which  add  to  the  difficulty  of  reaching  a 
clear  conclusion. 

According  to  the  United  States  census  of  1900,  the  male  popula- 
tion of  military  age,  namely  between  20  and  39  years  inclusive,  was 
12,466,309;  during  the  year  this  population  suffered  a  mortality  of 
95,070,  or  at  the  rate  of  7.62  per  thousand.  For  the  period  of  life 
from  20  to  29,  the  rate  was  7.11.  So  far  as  it  is  possible  to  ascer- 
tain, England,  France  and  Germany  have  about  the  same  ratio  of 
civil  mortality,  being  a  little  less  in  Germany  and  a  little  more  in 
France.  According  to  the  latest  American  life  insurance  tables, 


2  MILITARY    HYGIENE. 

7.80  per  thousand  of  young  men  20  years  old  die  annually  in  this 
country,  and  8.43  of  men  30  years  old.  According  to  the  United 
States  Life  Tables  for  1910  (probably  nearer  to  the  truth),  the 
mean  rate  of  mortality  in  the  registration  States  for  the  ten 
years  20  to  30,  was  5.50. 

•'How  then  does  military  mortality  compare  with  the  above?  By 
consulting  the  official  reports  of  the  last  few  years,  years  of  peace, 
the  figures  appear  quite  favorable  to  military  life.  Thus  we  find 
that  for  the  U.  S.  Army  ^exclusive  of  colonies)  the  total  mortality 
(from  disease,  accident  and  injury)  for  1909,  1910  and  1911  was 
4.84,  4.42  and  4.72  respectively,  or  an  average  of  4.66.  Great 
Britain  reports  2.42  for  1910,  France  3.75  for  1909,  Prussia  1.78 
for  1909  and  Russia  4.07  for  1909.  These  figures  show  that  the 
rates  for  the  U.  S.  Army  are  higher  than  those  of  the  leading 
European  countries,  but  that  they  are  all  under  those  prevailing  in 
civil  life.  A  further  study  of  the  subject,  however,  somewhat 
modifies  this  first  view.  It  is  found  that,  in  all  armies,  when 
soldiers  contract  incapacitating  diseases,  not  likely  to  be  cured 
within  a  short  time,  they  are  discharged  and  returned  to  civil  life, 
so  that  their  death,  instead  of  being  charged  to  army  statistics,  go 
to  increase  the  civil  rates.  Thus  in  1904,  the  proportion  of  dis- 
charges per  thousand  of  strength  was  48.40  in  the  French  Army, 
46.00  in  the  Prussian  Army  and  22.00  in  the  U.  S.  Army.  In  the 
British  Army  this  proportion  was  15.05  for  1905  and  only  8.65  for 
1909.  In  the  U.  S.  Army  it  increased  to  26  for  1906  and  fell  to 
15.28  in  1910. 

The  disease  which,  in  the  absence  of  epidemics,  makes  the  greatest 
number  of  victims,  is  tuberculosis.  In  the  French  and  German 
Armies  most  of  the  discharges  are  for  that  disease ;  as  soon  as 
a  case  of  it  is  clearly  diagnosed  the  patient  is  invalided  and  sent 
home  where  his  death  ultimately  swells  the  civil  rates.  In  our 
service,  such  a  patient  is  generally  sent  to  the  Army  sanatorium  at 
Fort  Bayard,  N.  M.,  and  his  death,  should  it  occur  there  before 
his  discharge,  credited  to  the  Army  rates. 

According  to  Viry  and  Marvaud,  the  ratio  of  mortality  in  the 
French  Army  should  be  increased  by  4  to  give  a  near  estimate  of 
the  number  of  deaths  fairly  attributable  to  military  life.  The  same 
correction  should  doubtless  be  made  for  the  German  Army.  These 
4  deaths  are  to  be  deducted  from  the  rates  of  civil  life,  but  owing 


MORBIDITY    AND    MORTALITY    IN    THE    MILITARY    SERVICE.  3 

to  the  large  population  of  military  age  in  France  and  still 
more  so  in  Germany,  this  deduction  would  only  amount  to  a  fraction 
of  one  per  thousand,  a  negligible  quantity.  It  is  presumed  that  an 
increase  of  2  would  fully  correct  the  rates  of  the  U.  S.  Army  and 
the  British  Army. 

However,  if,  instead  of  taking  the  mortality  irom  all  causes,  we 
simply  compare  the  death  rates  from  disease  only,  the  result  is  still 
more  clearly  in  favor  of  military  life,  for  it  is  a  fact  that,  in  the 
service,  in  time  of  peace,  more  men  die  of  injuries  and  violent 
death  than  in  civil  life.  Thus,  in  1900,  the  proportion  of  deaths 
from  accidents  and  injuries,  to  the  total  mortality,  in  the  male 
population  of  military  age  in  the  United  States,  was  only  17  per 
cent.,  while  in  the  U.  S.  Army  (exclusive  of  colonies)  this  propor- 
tion, for  the  three  years  1904-6,  is  43  per  cent. ;  the  rates  of  deaths 
from  disease,  for  those  years,  being  only  3.94,  3.55  and  2.84  per 
thousand  respectively.  The  death  rate  in  the  Army,  for  1910,  was 
2.44  from  disease  and  2.02  from  external  causes,  or  in  the  proportion 
of  55  to  45  per  cent.,  whereas  for  the  entire  population  of  the 
United  States  this  proportion  (suicides  excluded)  was  94  to  6. 
The  number  of  accidental  deaths  in  European  armies  is  not  as  hish 
as  in  our  service,  but  yet  decidedly  higher  than  in  the  civil  male 
population. 

It  is  plain,  therefore,  that  we  are  justified  in  stating  that,  in  time 
of  peace,  modern  armies  suffer  less  from  disease  than  the  corre- 
sponding male  civil  population.  This  is  due  largely  to  the  fact  that 
soldiers  are  subjected  to  a  careful  sifting,  whereby  all  applicants 
below  a  suitable  physical  standard  are  rejected;  but  it  is  also  an 
indubitable  proof  of  the  efficacy  of  scientific  sanitary  measures  when 
enforced  by  military  regulations  and  discipline. 

MORBIDITY  AND  MORTALITY  IN  TIME  OF  PEACE. 

The  diseases  of  the  soldier  in  time  of  peace  differ  from  those  of 
war  time  in  their  degree  of  prevalence  and  rates  of  mortality.  '  In 
th  U.  S.  Army  (exclusive  of  colonies),  for  the  three  years  1908- 
1910,  the  following  diseases  have  been  those  most  prevalent,  in  the 
order  named : 

Venereal  diseases,  tonsillitis,  bronchitis  (acute  and  chronic), 
diarrhea  (including  enteritis),  influenza,  alcoholism,  malarial  fevers, 
rheumatism,  measles,  mumps,  tuberculosis. 


4  MILITARY    HYGIENE. 

For  1915  the  five  most  prevalent  were  exactly  the  same  as  above 
and  in  about  the  same  order. 

In  the  U.  S.  Navy  and  Marine  Corps,  for  the  years  1909  and 
1910,  the  order  of  prevalence  was :  venereal  diseases,  tonsillitis,  skin 
diseases  (suppurative),  influenza,  bronchitis,  rheumatism,  diarrhea, 
malaria.  For  1915  the  order  was:  venereal  diseases,  tuberculosis, 
tonsillitis,  mumps,  appendicitis,  influenza,  bronchitis. 

In  the  British  Army,  at  home,  the  order  of  prevalence,  lor  1909, 
was :  venereal  diseases,  minor  septic  disorders  (boils,  abscesses, 
etc.),  tonsillitis,  digestive  diseases,  influenza,  bronchitis,  scabies, 
rheumatism. 

In  the  French  Army,  for  1907:  bronchitis,  venereal  diseases, 
mumps,  rheumatism,  influenza  and  measles. 

In  the  Prussian  Army,  for  1907:  bronchitis,  venereal  diseases, 
influenza,  rheumatism  and  pneumonia. 

The  preeminence  of  venereal  diseases  in  America  and  England, 
as  compared  with  continental  European  countries,  is  largely  due  to 
the  lack  of  the  safeguards  used,  for  instance,  in  France  and  Ger- 
many, where  prostitution  is  subject  to  police  regulations.  This 
matter  will  be  discussed  in  its  proper  place. 

Tonsillitis,  in  our  Army  and  Navy,  comes  second  in  the  order  of 
admissions,  while  bronchitis  is  not  far  below  it.  The  high  prev- 
alence of  tonsillitis  is  remarkable,  showing  the  sensitiveness  of  the 
tonsils  to  external  influences,  as  well  as  some  serious  defect  in  the 
ventilation  of  our  dormitories.  The  rate  begins  to  rise  as  soon  as 
winter  sets  in ;  then  the  barracks,  often  crowded,  are  tightly  shut 
and  the  air  becomes  overheated,  close,  ill-smelling ;  conditions 
most  favorable  to  the  spread  of  tonsillitis  by  air  infection,  and 
favorable  also  to  the  incidence  of  nasal,  pharyngeal  and  bronchial 
affections  mostly  included  under  the  general  heading  of  bronchitis. 
The  remedy  is  more  air  space  and  better  ventilation. 

Deaths  result  chiefly  from  the  following  diseases,  in  the  order 
named : 

In  the  U.  S.  Army,  for  the  years  1909-1911 :  tuberculosis,  pneu- 
monia, heart  disease,  typhoid  fever,  nephritis,  measles,  alcoholism, 
appendicitis.  For  1915:  pneumonia,  measles,  heart  disease,  tubercu- 
losis, appendicitis. 

In  the  U.  S.  Navy  and  Marine  Corps,  for  the  years  1909  and 
1910:  tuberculosis,  pneumonia,  heart  disease,  nephritis,  typhoid 


MORBIDITY    AND    MORTALITY    IN   THE    MILITARY    SERVICE.  5 

fever.  For  the  year  1915:  tuberculosis,  pneumonia,  nephritis,  heart 
disease,  appendicitis. 

For  the  entire  population  of  the  United  States,  the  five  leading 
causes  of  death,  in  1910,  were,  in  the  order  named:  tuberculosis, 
heart  disease,  diarrhea  and  enteritis,  pneumonia,  nephritis.  In  1914 
they  were  tuberculosis,  heart  disease,  nephritis,  diarrhea  and  en- 
teritis, cancer. 

In  the  British  Army,  for  1909 :  pneumonia,  tuberculosis,  heart 
disease,  nephritis,  typhoid  fever,  rheumatism. 

In  the  French  Army,  for  1907:  tuberculosis,  typhoid  fever,  pneu- 
monia, influenza,  scarlet  fever. 

In  the  Prussian  Army,  for  1907:  pneumonia,  tuberculosis, 
appendicitis,  typhoid  fever. 

It  is  admitted  that  in  military  medical  statistics,  the  rate  of  the 
constantly  non-effective,  that  is,  of  men  constantly  on  the  sick 
report,  is  the  true  measure  of  the  loss  in  efficiency  of  an  army 
from  sickness  and  injury.  The  non-effective  rates  per  thousand 
in  our  Army,  for  1909,  1910,  1911  and  1915,  were  42,  36,  33,  and 
25  respectively.  They  show  a  steady  and  much-needed  reduction 
during  the  past  decade.  The  rate  of  42,  for  1909,  corresponded  to 
a  loss  of  14.5  days  from  sickness  or  injury  for  each  soldier,  or  to 
3,083  men  constantly  excused  from  duty.  During  the  same  year, 
the  average  number  of  days  lost  by  each  British  workman  was  7. 
It  was  about  the  same  in  France  and,  presumably,  in  this  country. 
It  has  also  been  computed  that,  in  the  United  States,  for  each  death 
in  the  Army,  there  is  a  reported  period  of  sickness  several  times 
longer  than  for  each  death  in  civil  life.  In  the  U.  S.  Navy,  for 
1909  and  1910,  the  non-effective  rates  averaged  26.59,  correspond- 
ing to  9.70  days  of  sickness  for  each  man.  In  the  British  Army, 
for  1909,  these  rates  were  28.86,  the  average  sick  time  for  each 
soldier  being  10.39  days. 

It  is  evident  that  soldiers  in  most  armies,  but  especially  ours,  are 
often  excused  from  duty  for  reasons  which  would  not  appear  suffi- 
cient to  keep  workmen  or  mechanics  away  from  their  daily  task. 
To  some  extent  this  is  inevitable,  but  it  is  an  indulgence  that,  in 
the  interest  of  the  service  and  of  the  men  themselves,  should  be 
guarded  with  discretion  and  judgment  and  never  permitted  to  go 
beyond  reasonable  limits.  It  is  certain  that  our  soldiers,  as  a  gen- 
eral rule,  have  been  too  easily  admitted  to  hospital  and  quarters 


6  MILITARY    HYGIENE. 

and  kept  there  longer  than  necessary,  and  that  a  little  more  strict- 
ness in  that  regard  on  the  part  of  medical  officers  would  work 
neither  injury  nor  hardship  to  any  one.  It  is  a  matter  of  common 
observation  that  those  posts  where  the  medical  department  is  most 
efficiently  conducted,  nearly  always  show  the  lowest  sick  report. 
It  is  also  remarkable  that  in  summer  camps,  where  the  troops  are 
subject  to  many  discomforts  and  often  destitute  of  suitable  sanitary 
appliances,  the  sick  report  is  seldom  more  than  half  that  of  troops 
in  garrison.  This  is  because  the  men  are  kept  busy  and  interested 
in  their  work,  temptations  to  dissipation  are  fewer,  and  the  sanitary 
service  is  under  the  direction  of  selected  medical  officers. 

Inasmuch  as  venereal  diseases  make  up  one-fifth  of  all  admis- 
sions, it  is  hoped  that  the  systematic  measures  of  prophylaxis  now 
becoming  more  generally  employed,  together  with  the  careful  appli- 
cation of  the  recent  law  stopping  the  pay  of  officers  and  men  under 
treatment  for  disease  resulting  from  misconduct,  will  materially 
reduce  the  rates  of  these  affections. 

The  stricter  rules  now  enforced  to  get  rid  of  incurables  and  of 
cases  not  likely  to  recover  within  a  reasonable  time  also  tend  to 
greater  efficiency. 

In  comparing  our  death  rates  with  those  of  other  armies,  it  should 
be  remembered  that  our  Army  contains  a  certain  proportion  of 
negro  troops,  amounting  to  4  or  5  per  cent.,  and  that  their  mor- 
tality from  disease  is  nearly  double  that  of  white  soldiers. 

MORBIDITY  AND  MORTALITY  IN  WAR. 

In  time  of  war,  sanitary  conditions  are  necessarily  very  different 
from  those  which  should  prevail  in  time  of  peace.  Then  everything 
is  ruthlessly  sacrificed  to  strategic  exigencies,  that  is  to  say,  the 
necessity  of  confronting  the  enemy  as  quickly  as  possible,  in  the  best 
position  and  with  the  greatest  number  of  men.  But,  even  then,  on 
the  march  or  the  battlefield,  sanitary  considerations  should  never 
be  overlooked  or  neglected,  for  hygiene  is  a  source  of  strength  to 
an  army  at  all  times.  During  a  campaign,  soldiers  are  likely  to 
suffer  bodily  from  inclement  weather,  heat,  cold  or  rain,  lack  of 
shelter,  improper  or  badly  cooked  food,  overstrain  and,  mentally, 
from  excitement  and  anxiety.  Hence,  digestive  and  intestinal  dis- 
orders, rheumatic,  respiratory,  cardiac  and  nervous  affections. 
Furthermore,  the  soldier  is  greatly  exposed  to  infectious  diseases 
and,  until  hardened  by  rough  service,  more  susceptible  to  them. 


MORBIDITY    AND    MORTALITY    IN    THE    MILITARY    SERVICE. 


S.oa      /.J~o 


e  re  u 


FIG.  i. —  Chart  showing  the  relative  admission,  death,  discharge,  and  non- 
effective  ratios  per  thousand  of  mean  strength  for  the  five  diseases  causing 
the  highest  rates  in  the  United  States  proper,  for  the  year  1915. 


8  MILITARY    HYGIENE. 

The  concentration  of  regiments  in  one  camp  or  position  cannot 
always  be  avoided,  while  sanitary  measures  can  only  be  imperfectly 
applied.  The  result  has  been,  almost  invariably,  that  until  the 
beginning  of  this  century,  the  morbidity  and  mortality  from  disease, 
in  war,  rapidly  increased  and  soon  exceeded  the  rates  of  the 
wounded  and  killed  in  battle.  A  few  modern  historical  instances 
will  impress  this  melancholy  fact  upon  the  mind. 

During  the  Mexican  War  of  1846-47,  22  per  cent,  of  the  Ameri- 
can regulars  died  and  14  per  cent,  were  invalided  from  disease, 
while  only  5  per  cent,  were  killed  in  battle  or  died  from  wounds. 

During  the  Crimean  War  of  1854-56,  the  French  lost  from  dis- 
ease, in  round  numbers,  70,000  out  of  310,000  men,  or  nearly  23 
per  cent.,  while  65,000  were  invalided  home.  Only  7,500  fell  in 
battle.  In  the  same  war  the  British  lost  21,000  men  from  disease 
out  of  111,000. 

For  the  Civil  War,  1861-65,  the  record  is  as  follows : 
Killed  in  battle,  44,238 

Died  of  wounds,  49,731 

Died  of  disease,  186,216 

Died,  cause  unknown,       24,184 

Leaving  out  of  reckoning  those  who  died  from  unknown  cause, 
it  is  seen  that  for  each  man  killed  or  dead  from  wounds,  two  died 
from  disease. 

In  the  Franco-Prussian  War,  1870-71,  the  French  mortality  from 
disease  vastly  exceeded  that  from  battle,  but  reliable  statistics  are 
not  available.  The  Germans  lost  17,255  in  killed  and  14,904  from 
disease,  the  first  conspicuous  exception  to  the  rule  that,  in  war,  more 
men  die  from  disease  than  from  gunshot. 

For  the  Spanish- American  War,  during  the  year  1898,  the  record 
is  as  follows : 

From  battle.        From  disease. 
Cuba,  273  deaths.       567  deaths. 

Camps  in  United  States,     ....   deaths.    2,649  deaths. 
Philippine  Islands,  17  deaths.       203  deaths. 

Porto  Rico,  3  deaths.       262  deaths. 


Total,  293  deaths.    3,681  deaths, 

or  i  death  from  battle  to  12.5  deaths  from  disease. 

In  the  war  between  China  and  Japan,  1894-95,  out  of  227,600 
Japanese  brought  into  the  field,  15,850  died  of  disease  and  1,311 
from  wounds,  a  proportion  of  12  to  i. 


MORBIDITY    AND    MORTALITY    IN    THE    MILITARY    SERVICE.  9 

In  the  Boer  War,  1899-1901,  out  of  a  total  British  force  of 
448,000  men,  7,534  died  from  wounds  and  14,382  from  disease 
(Report  of  Insurance  Actuaries)  ;  in  addition,  63,644  sick  and  8,221 
wounded  were  invalided  home. 

It  would  be  irrational,  however,  to  attach  much  importance  to 
this  comparison  of  ratios  between  the  sick  and  the  wounded,  or 
estimate  from  it  the  sanitary  condition  of  an  army.  These  ratios 
are  not  necessarily  correlated  and  remain  more  or  less  independent 
of  each  other.  Thus  although  the  sanitary  status  of  troops  may  be 
excellent,  the  ratio  of  sick  will  greatly  exceed  that  of  the  wounded 
if  there  be  no  severe  fighting.  The  bad  showing  made  by  the 
statistics  of  the  Spanish-American  War,  in  this  regard,  is  not  so 
much  the  result  of  a  high  proportion  of  sick  as  it  is  that  of  an 
unusually  low  ratio  of  wounded.  As  a  general  rule  it  can  be  stated 
that  a  bloody  and  decisive  campaign,  of  short  duration,  will  be 
attended  with  much  less  sickness  than  one  consisting  of  ineffective 
engagements  covering  a  long  period  of  time.  Nothing  is  more 
detrimental  to  the  health,  as  well  as  to  the  morale  of  an  army,  than 
a  long-dragged  out,  indecisive  campaign,  under  a  pusillanimous 
commander. 

The  Russo-Japanese  War,  1904-5,  marks  a  new  epoch  in  military 
hygiene  by  demonstrating  the  possibility,  even  in  wars  of  great 
magnitude,  to  keep  the  rates  of  disease  much  below  what  had  always 
been  considered  as  the  irreducible  minimum.  In  a  war  of  nearly 
two  years'  duration,  the  dead  from  disease  were  only  about  one-half 
the  number  of  killed ;  often  the  percentage  of  sickness  among  both 
belligerents  was  lower  than  that  of  garrisons  at  home.  Although 
the  usual  diseases  were  present,  none  prevailed  in  an  epidemic  form, 
except  beriberi,  which  appears  to  have  been  nearly  as  widespread 
among  the  Japanese  as  during  their  previous  wars,  in  spite  of 
persistent  efforts  to  eradicate  it. 

The  following  is  the  official  Japanese  statement  for  the  entire  war 
(including  Port  Arthur)  : 

Total  killed  and  wounded  220,812 

Total  sick  236,223 

Killed  in  battle  and  died  of  wounds,         58,887 
Died  of  sickness,  27,158 

If  we  estimate  the  total  strength  of  the  Japanese  in  the  zone  of 
operations  at  700,000,  we  obtain  a  percentage  of  8.41  for  the  killed 
and  of  3.88  for  the  dead  from  sickness. 


IO  MILITARY    HYGIENE. 

The  official  statistics  of  the  Russian  Army  (exclusive  of  Port 
Arthur)  are  as  follows : 

Total  killed  and  wounded,  140,953 

Total  sick,  237,472 

Killed  in  battle  or  died  from  wounds,         23,008 
Died  of  disease,  18,830 

Missing,  39<729 

No  satisfactory  official  explanation  has  been  offered  to  account 
for  this  exceedingly  large  number  of  missing.  The  number  of 
deserters  to  the  hostile  Chinese  cannot  have  been  very  great.  It 
seems  more  probable  that  a  large  proportion  of  them,  perhaps  a 
majority,  should  be  counted  as  among  the  killed.  Both  Col.  Hoff 
and  Dr.  Follenfant,  medical  attaches  with  the  Russian  Army,  esti- 
mate at  about  14,600  the  missing  which  should  be  added  to  the 
number  of  killed,  thus  increasing  the  latter  to  37.608.  But  it  seems 
logical  that,  of  the  remaining  missing,  should  be  also  deducted  a 
certain  proportion  of  men  taken  sick  along  the  extended  lines  of 
positions  and  left  to  die  in  Chinese  villages  unaccounted  for.  It  is 
believed  that  3,000  or  4,000  might  thus  be  properly  added  to  the 
dead  from  disease. 

Regarding  Port  Arthur,  it  is  known  that  the  Russian  garrison 
did  not  exceed  55,000,  and  that  the  number  surrendered  was  41,000, 
of  whom  800  subsequently  died  (Seaman).  It  is  estimated  by  Kuhn 
that  at  least  10,000  were  killed,  so  that  less  than  5,000  must  have 
died  of  disease. 

In  thus  endeavoring  to  account  for  a  certain  proportion  of  the 
missing,  and  by  the  inclusion  of  the  Port  Arthur  statistics,  the 
following  corrected  estimates  are  obtained : 

Killed  in  battle,  as  officially  reported,  23,008 

Added  from  the  missing,  14,600 

Killed  at  Port  Arthur,  10,000 


Total   killed,  47,608 

Died  of  disease,  as  officially  reported,  18,830 

Added   from  the  missing.  4,000 

Died  of  disease  at  Port  Arthur,  5,000 

Total  dead  from  disease,  27,830 

Although  the  Russians  brought  over  a  million  men  into  Man- 
churia, it  may  safely  be  estimated  that  the  number  present  in  the 


MORBIDITY    AND    MORTALITY    IN    THE    MILITARY    SERVICE.  IT 

zone  of  active  operations  did  not  exceed  650,000 ;  on  such  basis  we 
obtain  a  percentage  of  7.32  for  the  killed  and  4.28  for  the  dead  from 
disease. 

Were  we  to  take  into  consideration  the  fact  that  the  large  con- 
tingents of  Japanese  and  Russians,  outside  the  zone  of  active  opera- 
tions, were  also  subjected  to  those  field  conditions  which  favor  the 
spread  of  camp  diseases,  the  rates  for  disease  as  above  stated  could 
be  still  further  reduced. 

The  common  diseases  of  war. —  The  two  diseases  which  formerly 
caused  most  of  the  frightful  mortality  of  military  camps  were 
typhus  and  cholera.  Typhus,  the  febris  bellica  of  older  writers,  was 
the  scourge  of  armies  during  the  wars  of  the  i8th  century  and  of 
the  Napoleonic  era,  as  late  as  the  Crimean  War,  where  it  made 
more  victims  than  all  other  diseases  combined.  Under  the  influence 
of  better  hygienic  habits  it  has  practically  disappeared  from  the 
United  States  where  it  is  rarely  found  under  the  mild  form  of 
Brill's  disease.  It  is  common  in  Mexico  under  the  name  of  tab- 
ardillo.  Sporadic  cases  are  still  seen  in  many  parts  of  Europe  and 
Asia ;  thus  during  the  Russo-Japanese  War  it  was  seldom  absent 
from  the  Russian  base  hospitals.  It  is  endemic  in  Galicia  and  the 
Balkan  States,  and  became  epidemic  in  Servia  in  the  early  part  of 
the  European  War  (see  page  81). 

Cholera  has  not  been  an  important  factor  in  the  mortality  of  late 
wars,  having  last  prevailed  in  an  epidemic  form  in  the  Sino- Japanese 
War  of  1894,  but  it  has  so  many  endemic  foci  in  various  parts  of 
Asia  and  Eastern  Europe  that  it  continues  to  be  a  serious  menace, 
especially  to  our  troops  serving  in  the  Philippine  Islands.  Serious 
outbreaks  of  it  were  reported  from  the  armies  operating  in  Galicia 
and  parts  of  Poland  in  1915  (see  page  51). 

Scurvy,  the  result  of  defective  alimentation,  was  also  common 
formerly  in  armies,  especially  when  besieged  and  cut  off  from  fresh 
supplies.  Being  an  easily  preventable  disease  it  is  now  rarely  seen. 

In  the  Mexican  War,  the  principal  disease  is  reported  to  have 
been  diarrhea  of  an  aggravated  type ;  probably  this  covered  many 
cases  of  typhoid  fever. 

In  the  Crimean  War,  the  most  fatal  diseases  were  typhus,  cholera 
and  typhoid  fever. 

In  the  Civil  War,  the  prevalent  diseases,  in  order  of  their  admis- 
sions, were  dysentery  and  diarrhea,  malaria,  respiratory  diseases, 


12  MILITARY    HYGIENE. 

rheumatism,  venereal  diseases  and  typhoid  fever.  The  most  fatal 
were  typhoid  fever,  dysentery  and  diarrhea,  which  have  continued 
to  be  the  chief  causes  of  death  in  military  camps  ever  since. 

During  the  year  of  the  Franco-Prussian  War,  the  German  Army 
had  over  73,000  cases  of  typhoid  fever,  equivalent  to  a  rate  of 
admission  of  9.31  per  cent,  of  all  sickness. 

During  the  Spanish-American  War,  the  prevalent  diseases,  in 
order  of  their  admissions,  were  malaria,  dysentery  and  diarrhea, 
typhoid  fever,  respiratory  diseases  and  venereal  diseases.  The  most 
fatal  were  typhoid  fever  for  the  volunteer  camps  in  the  United 
States,  malaria  and  dysentery  for  the  Philippine  expedition,  and 
malaria  and  yellow  fever  for  the  Santiago  expedition. 

In  the  Sino- Japanese  war,  the  mortality  resulted  chiefly  from 
cholera,  dysentery  and  beriberi. 

In  the  Boer  War,  about  one-half  of  the  disease  mortality  was 
from  typhoid  fever,  while  dysentery  and  diarrhea  made  the  next 
greatest  number  of  victims. 

In  the  Russo-Japanese  War,  the  Japanese  suffered  chiefly  from 
beriberi,  or  kakki,  a  nutritional  disease  to  which  the  Nippon  race  is 
particularly  susceptible,  more  than  one-third  of  the  total  sickness 
being  due  to  it  (84,545  cases  according  to  Seaman),  with  mortality 
of  5  or  6  per  cent.  Dysentery  and  typhoid  fever  were  the  only  other 
notable  infectious  diseases,  but  the  number  of  cases  of  either,  as 
officially  reported,  never  exceeded  i  per  cent,  of  all  sickness.  The 
case  mortality,  however,  was  very  high  in  both  diseases. 

In  the  Russian  Army,  the  infectious  diseases  which  caused  most 
of  the  mortality  were  typhoid  fever  and  dysentery ;  then,  as  second- 
ary factors  may  be  mentioned,  in  order  of  their  importance,  typhus, 
variola,  relapsing  fever  and  scurvy.  From  the  beginning  of  the 
war  to  July  14,  1905,  there  wTere  10,449  cases  of  typhoid  fever  with 
1,041  deaths;  on  September  i,  the  number  had  increased  to  17,033 
cases  with  2,077  deaths.  The  number  of  cases  of  dysentery  was 
approximately  one-half  that  of  typhoid  fever,  with  a  mortality  of 
5  to  6  per  cent. 

In  the  great  European  War  still  raging  (1917),  we  find  a  notable 
increase  in  the  number  and  gravity  of  wounds  (page  14),  but  no 
tendency  to  the  spread  of  infectious  diseases,  thanks  to  the  general 
use  of  the  sanitary  weapons  with  which  the  modern  military  surgeon 
is  armed.  In  spite  of  the  very  insanitary  condition  of  the  trenches 


MORBIDITY    AND    MORTALITY    IN    THE    MILITARY    SERVICE.  13 

and  dugouts  in  which  much  of  their  time  is  spent,  the  health  of  the 
troops  of  all  the  belligerents  has  been  surprisingly  good,  rather 
improving  than  deteriorating  with  length  of  service.  Outbreaks 
of  typhoid  fever,  typhus  and  cholera  occurred  during  the  first  year 
of  the  war,  but  were  soon  overcome.  Since  1915,  the  armies  of  all 
belligerents  have  been  practically  free  not  only  from  epidemics,  but 
from  marked  prevalence  of  any  serious  disease,  and  claim  to  enjoy 
better  health  than  while  in  garrison,  before  the  war. 

This  remarkable  control  of  preventive  medicine  over  those  infec- 
tious diseases  which  formerly  decimated  troops  in  campaign,  often 
a  greater  menace  than  the  enemy,  is,  from  the  view-point  of  the 
humanitarian,  the  great  wonder  of  our  day  and,  for  the  military 
surgeon,  an  incentive  and  stimulus  to  continued  exertions  and  the 
attainment  of  still  more  perfect  results. 

Also  worthy  of  notice  is  the  expedition  of  10,000  American  troops 
which,  in  March,  1916,  crossed  the  Rio  Grande  and  entered  northern 
Mexico  in  pursuit  of  raiding  insurgents.  During  several  months 
of  arduous  service  under  the  most  trying  climatic  conditions,  these 
troops  maintained  a  remarkable  record  of  health  and  efficiency,  their 
non-effective  rates  comparing  favorably  with  the  best  of  the  home 
troops  under  garrison  conditions. 

CHARACTER  OF  WOUNDS  IN  THE  PRESENT  EUROPEAN 
WAR   (1917). 

The  number  and  nature  of  the  wounds  received  on  battlefields  do 
not  directly  pertain  to  the  domain  of  hygiene,  but  a  brief  considera- 
tion of  the  subject  may  be  useful,  especially  to  show  the  decided 
influence  upon  them  of  environment,  and  the  necessity  of  freeing 
this  environment  of  at  least  its  most  harmful  features. 

Until  the  present  world  war,  wounds  by  rifle  (or  machine  gun) 
fire  had  always  formed  a  large  majority  of  casualties.  Thus  their 
percentages  were  91  in  our  Civil  War,  89  in  the  Franco-Prussian 
War,  84  in  the  Russo-Japanese  War,  while  in  the  present  war  it  is 
only  about  55.  This  decreasing  rate  shows  that  the  part  played  by 
artillery  (shrapnel,  shell  fragments,  etc.)  and  grenades  has  been 
steadily  growing  in  importance,  causing  from  less  than  one-tenth  of 
total  wounds  in  the  Civil  War,  to  about  one-half  in  the  present 
world  conflict.  It  is  to  be  observed,  however,  that  for  the  Crimean 
War,  Chenu  reports  a  percentage  of  54  for  rifle  fire  and  46  for 


14  MILITARY    HYGIENE. 

artillery.  Inasmuch  as  the  Crimean  War  was  also  mostly  waged 
from  trenches,  it  would  seem  that  this  great  increase  of  the  deadly 
power  of  artillery  is  largely  due  to  the  present  mode  of  warfare 
from  field  intrenchments. 

This  greater  proportion  of  artillery  casualties  also  accounts  for 
the  higher  ratio  of  killed.  Thus,  before  the  present  war,  the  ratio 
of  i  killed  to  4  wounded  was  the  generally  accepted  average.  But, 
according  to  British  reports,  the  ratio  was  i  killed  to  3.4  wounded 
in  the  first  year  of  the  war,  and  i  to  3  in  1917,  while  in  trench 
warfare  it  is  estimated  to  be  i  to  2.  . 

The  remarkable  effect  of  preparedness,  training  and  experience 
on  the  part  of  the  medical  department  is  clearly  shown  in  this  war. 
Thus  the  Germans  reported,  in  November,  1914,  that,  of  the 
wounded  in  hospitals,  2:1  per  cent,  died  and  87  per  cent,  were 
returned  to  duty,  and  in  April,  1915,  that  91  per  cent,  were  returned 
to  duty  and  only  1.4  died. 

In  the  French  hospitals,  the  mortality  for  disease  was  2.9  per 
cent,  during  the  first  year  of  the  war,  and  1.4  during  the  succeeding 
8  months ;  while  for  wounds,  the  mortality  was  3.4  during  the  first 
year  and  1.5  during  the  succeeding  8  months.  In  December,  1915, 
86  per  cent,  of  the  wounded  were  returned  to  duty. 

A  larger  proportion  of  wounds  than  formerly,  especially  of  those 
received  in  trenches,  are  severe  and  extensive,  while  nearly  all  are 
infected.  A  small  proportion  of  rifle  wounds  heal  by  first  intention, 
or  nearly  so,  but  most  of  them,  as  well  as  all  artillery  wounds,  suffer 
from  septic  infection,  often  of  a  severe  type.  This  surprising  state 
of  affairs  is  due  to  the  two  factors  of  insanitary  environment  and  of 
the  extensive  lacerations  and  contusions  of  the  wounds.  When  on 
duty  in  the  trenches  the  soldier's  clothing  is  begrimed  with  mud 
and  filth,  and  the  skin  smeared  with  dirt,  so  that  myriads  of  bacteria 
are  carried  into  the  wounds  with  the  projectiles. 

Of  these  bacteria  the  most  dangerous  are  the  bacillus  of  tetanus 
and  the  bacillus  aerogenes  capsulatus  of  Welch.  '  The  pyogenic 
organisms  come  next  in  importance  and,  among  them,  streptococcus 
fecalis  is  the  most  frequently  found.  This  is  ascribed  to  its  uni- 
versal presence  in  the  terrain  which  comprises  the  intensive  farming 
district  of  the  western  front.  Staphylococci,  bacillus  pyocyaneus 
and  the  colon  bacillus  are  next  in  order  of  frequency  "  (La  Garde). 

The  bacillus  aerogenes  capsulatus  (b.  perfringes  of  the  English 


MORBIDITY    AND    MORTALITY    IN    THE    MILITARY    SERVICE.  15 

and  French)  is  generally  considered  the  cause  of  gas  gangrene 
which  was  such  a  frequent  and  terrible  complication  of  lacerated 
wounds  during  the  first  months  of  the  war.  "  The  following  signs 
are  very  suspicious  of  infection  by  the  gas  bacillus:  The  wound 
presents  a  dirty,  sloughing  appearance ;  a  dirty  serous  exudate 
escapes  from  it,  as  well  as  bubbles  of  gas ;  crepitation  under  the  skin 
is  felt,  and  a  f ecal-like  odor  emanates  from  the  discharge ;  the  adja- 
cent tissues  are  reddened  as  in  cellulitis,  edematous  and  tender  " 
(La  Garde).  The  abundant  gas  production  causes  rapidly  spread- 
ing emphysema,  and  the  mechanical  pressure  of  the  effusion  and 
gas  obstructs  the  circulation,  with  resulting  gangrene. 

The  treatment  now  generally  successful  in  all  septic  wounds  con- 
sists in  very  free  incisions  reaching  all  pockets  and  sinuses  likely 
to  be  infected,  and  irrigation  with  Dakin's  preparation,  or  saline 
solutions,  by  means  of  rubber  tubes  with  branches  extending  to 
all  the  remote  parts  of  the  wound  (Carrel  method). 

MORBIDITY   AND    MORTALITY   IN   TROPICAL    COUNTRIES. 

Mortality  has  been  in  the  past,  and  is  still  now,  much  higher  in 
tropical  than  in  temperate  climates.  This  is  due  chiefly  to  the 
ignorance  of  hygienic  laws  and  neglect  of  public  and  personal 
sanitation,  whereby  favorable  conditions  are  created  for  the 
propagation  of  pathogenic  organisms,  such  as  those  of  malaria, 
tuberculosis,  dysentery,  cholera,  plague,  yellow  fever,  dengue  and 
leprosy.  It  cannot  be  denied,  however,  that  these  organisms  are 
more  or  less  influenced  in  their  rate  of.  growth  and  virulence  by 
climatic  conditions. 

The  diseases  above  named,  and  others  from  which  the  natives  of 
hot  countries  suffer,  such  as  beriberi  and  various  intestinal  parasitic 
disorders,  are  all  preventable,  in  the  usual  sense  of  the  word,  by  the 
application  of  well-known  sanitary  measures.  On  the  other  hand, 
the  several  acute  diseases  which,  in  temperate  and  cold  countries, 
produce  a  large  proportion  of  the  mortality,  such  as  pneumonia, 
acute  and  chronic  nephritis,  cerebrospinal  meningitis,  cancer,  bron- 
chitis, diphtheria,  etc.,  are  comparatively  rare  in  the  tropics,  where, 
furthermore,  all  the  specific  exanthemata  (small-pox,  measles,  scar- 
let fever,  etc.)  are  very  mild..  It  follows,  therefore,  that  the  mor- 
tality of  tropical  lands  need  not  be  necessarily  higher  than  in  other 
countries  and  that,  as  anywhere  else,  it  is  mostly  a  matter  of  care- 


l6  MILITARY    HYGIENE. 

ful  and  intelligent  hygiene.  Thus  the  rate  of  deaths  in  Havana 
during  the  decade  preceding  the  Spanish  War  was  36  per  1,000; 
under  American  administration  and  sanitation  this  rate  fell  speedily 
to  21 .  For  the  entire  island  of  Cuba  it  was  17.35  m  I9°°.  grad- 
ually falling  to  13.96  in  1911.  During  the  year  1902,  our  Army 
was  about  equally  divided  between  the  United  States  and  the  Pacific 
Islands ;  while  at  home  the  mortality  from  disease  was  only  5  66 
per  1,000,  it  was  20.85  in  the  Islands ;  but,  in  1903,  after  our  medical 
officers  had  learned  how  to  contend  against  the  diseases  that  beset 
them  in  their  new  surroundings,  the  mortality  fell  to  11.14  in  the 
Philippines  and  has  steadily  continued  to  decrease.  In  the  same 
year,  the  ratio  of  deaths  in  Cuba  and  Porto  Rico  was  only  3.36, 
notably  lower  than  in  the  United  States. 

The  mortality  of  Manilla,  P.  L,  is  still  very  high  for  the  natives, 
among  whom  sanitary  laws  are  difficult  of  enforcement,  but  for  the 
American  population  it  was  only  9.05,  and  for  the  Spanish  popula- 
tion 15.45  per  thousand,  in  1904,  a  rate  considerably  below  that  of 
New  York  City. 

For  the  three  years  1908-1910,  the  death  rate  from  disease  among 
our  troops  in  the  United  States  was  3.10,  2.97  and  2.30  respectively, 
and,  in  the  Philippines,  5.03,  4.09  and  3.08,  showing  a  notable  de- 
crease from  year  to  year,  with  closer  approximation  of  rates,  in  both 
countries.  For  1915,  the  principal  causes  of  admission,  death  and 
non-effectiveness  in  the  Philippines,  with  rates  for  each,  are  indi- 
cated in  Fig.  2. 

For  1915,  the  non-effective  rate  in  the  Philippines,  for  disease 
alone,  was  21.42  as  against  20.90  in  the  United  States.  On  the 
other  hand,  the  death  rate  for  disease  was  only  1.61  as  against  2.53 
in  the  United  States. 

Hawaii,  as  would  be  expected  from  its  equable  and  salubrious 
climate,  has  lower  rates  for  admission,  non-effective,  discharge 
and  death  than  the  United  States.  Thus,  for  1914  and  1915,  its 
death  rates  were  1.63  and  3.04  respectively,  as  compared  with  4.82 
and  5.42  in  the  United  States. 

In  the  Isthmian  Canal  Zone,  the  total  population,  including 
Panama,  Colon  and  all  employes,  for  the  year  ending  June  30,  1907, 
was  87,215  with  a  death  rate  of  42.08.  For  the  white  employes 
(7,727)  the  rate  was  15.93,  and  for  negro  employes  (25,360, 
mostly  from  Jamaica  and  the  Barbadoes),  45.34.  That  the  death 


MORBIDITY    AND    MORTALITY    IN    THE    MILITARY    SERVICE. 


FIGt  2- — Chart  showing  (for  American  troops)  the  relative  admission, 
discharge,  death,  and  noneffective  rates  per  thousand  of  mean  strength  for 
the  diseases  causing  the  highest  rates  in  the  Philippine  Islands,  for  1915. 


l8  MILITARY    HYGIENE. 

rate  of  negroes  should  be  three  times  that  of  whites,  in  a  tropical 
climate,  is  most  remarkable.  It  would  be  interesting  to  know  how 
much  of  this  discrepancy  is  due  to  the  higher  power  of  adaptation 
and  resistance  of  the  white  race ;  it  seems  more  probable  that  it 
should  be  mostly  attributed  to  the  great  difficulty  of  enforcing  sani- 
tary regulations  among  ignorant  negroes.  Among  all  the  employes, 
white  and  black,  the  most  fatal  diseases,  in  the  order  of  their  mor- 
tality, were  pneumonia  (especially  among  the  colored),  malarial 
fever,  typhoid  fever,  tuberculosis,  acute  and  chronic  nephritis, 
dysentery,  septicemia,  heart  disease  and  meningitis. 

In  1910,  the  general  mortality  of  all  employes  was  21.18  per 
1,000.  For  disease  only,  it  was  4.92  for  whites  and  8.39  for  negroes ; 
the  chief  causes  of  death  for  whites  being,  in  the  order  named: 
malaria,  pneumonia,  nephritis,  tuberculosis.,  heart  disease;  and  for 
negroes,  tuberculosis,  pneumonia,  malaria,  nephritis  and  heart  dis- 
ease. In  1911,  the  death  rate  for  the  Zone,  including  the  cities  of 
Panama  and  Colon,  was  21,  while  that  of  the  American  whites  (men, 
women  and  children)  was  only  4.48. 

Among  the  6,000  American  troops  serving  in  the  Zone  in  1915, 
the  non-effective  and  death  rates,  for  disease  alone,  were  21.66  and 
1.31  respectively,  as  compared  with  20.90  and  2.99  among  troops 
in  the  United  States. 

Influence  of  Race. 

From  tables  prepared  by  Chamberlain*  for  the  ten  years  1905- 
1914  for  American  troops  serving  in  the  United  States,  it  appears 
that,  for  disease  only,  the  colored  soldiers  had  slightly  smaller 
admission,  discharge  and  non-effective  rates  than  white  soldiers, 
but  a  much  larger  death  rate,  in  the  ratio  of  5.1  to  2.7  per  1,000. 

For  the  same  period  of  ten  years  among  American  troops  in  the 
Philippines,  the  tables  show  that  the  colored  soldiers  had  smaller 
non-effective  and  discharge  rates  but  higher  admission  and  death 
rates,  the  latter  being  5.5  and  3.2  respectively  per  thousand. 

For  1915,  in  the  Philippines,  the  rates  of  colored  troops  for  admis- 
sion, non-effectiveness  and  death  exceed  those  of  white  troops,  the 
death  rates  being  5.22  and  1.04  respectively. 

In  1914  and  1915  the  white  troops,  in  the  entire  Army,  had  the 
higher  admission  rate,  while  the  colored  troops  had  the  higher  death, 
discharge  and  non-effective  rates. 

*  The  Military  Surgeon,  December,  1916. 


MORBIDITY    AND    MORTALITY    IN    THE    MILITARY    SERVICE.  19 

Comparing  the  four  races  making  up  our  military  strength,  we 
find  that  in  1915  their  rates  are  as  follows: 

Constantly  non-effective :  Colored,  28.46 ;  white,  25.70 ;  Porto 
Ricans,  22.78;  and  Philippine  Scouts,  15.68  per  1,000. 

Discharge:  Colored,  15.85;  white,  14.16;  Philippine  Scouts,  11.44; 
and  Porto  Ricans,  7.34  per  1,000. 

Death:  Colored,  5.51;  white,  4.54;  Porto  Ricans,  4.41;  and 
Philippine  Scouts,  2.54  per  1,000. 

The  average  number  of  days  lost  for  each  case  treated  was :  Porto 
Ricans,  14.98;  colored,  14.12;  white,  12.59;  and  Philippine  Scouts, 
9.97. 

From  the  above  statistics  and  those  relative  to  the  Isthmus  of 
Panama,  we  may  conclude  that  the  negro  shows  about  the  same 
degree  of  resistance  that  the  white  does  to  the  exposure  and  hard- 
ships incident  to  military  service,  as  shown  by  admission  and  non- 
effective  rates,  but  that,  as  in  civil  life,  when  attacked  by  a  serious 
illness,  he  is  more  easily  overcome  and  liable  to  die,  especially  from 
tuberculosis  and  pneumonia. 

The  greater  vitality  of  the  white,  as  shown  by  his  lo\ver  mortality, 
is  apparent  not  only  in  temperate  but  also  in  tropical  zones,  and 
this  notwithstanding  the  fact  that  white  troops,  in  the  last  decade, 
had  three  times  as  many  admissions  for  alcoholism  as  colored  troops, 
and  fifty  times  as  many  as  Filipinos.  It  is  generally  conceded  that 
the  colored  race  was  developed  with  special  adaptation  to  warm 
climates,  but  such  adaptation,  as  compared  with  the  white  race,  only 
becomes  evident  after  a  long  period  of  years.  Were  troops  of  both 
races  to  serve  together  ten  or  fifteen  years  \vithin  the  tropics,  there 
is  hardly  any  doubt  that  the  negro  would  in  the  end  manifest  a 
higher  degree  of  resistance  and  vitality  than  the  white,  provided 
they  performed  similar  duties  and  were  protected  by  about  the  same 
hygienic  conditions. 

Concerning  Filipino  troops,  we  find  that  their  rates  of  admission, 
non-effectiveness  and  death,  from  disease,  are  much  lower  than  for 
American  troops  serving  in  the  Philippines  or  in  the  United  States. 
The  difference  became  particularly  marked  in  1910,  after  the  eradi- 
cation of  beriberi,  the  disease  previously  most  prevalent  among 
them. 

In  Porto  Rico,  the  admission  and  non-effective  rates  for  native 
troops,  in  1911,  were  lower  than  for  white  troops  in  the  United 


2O  MILITARY    HYGIENE. 

States,  but  the  death  rate  was  higher.  In  1915  the  non-effective, 
discharge  and  death  rates  were  smaller  than  for  white  troops  at 
home, 

Influence  of  Age  and  Length  of  Service. 

The  experience  of  the  U.  S.  Army  and  of  all  other  armies  is  that 
the  admission  rate  to  sick  report  is  highest  for  young  soldiers 
under  20  years  of  age.  This  is  especially  true  of  typhoid  fever. 
Then  the  admission  rate,  as  well  as  the  discharge  and  non-effective 
rates,  fall  rapidly  up  to  the  age  of  about  45.  The  death  rate  is 
highest  in  young  soldiers,  19  years  and  under,  but  declines  after  20 
and  reaches  it  minimum  between  25  and  30  years,  rising  again 
slowly  up  to  40  years  and  rapidly  thereafter. 

From  the  point  of  view  of  length  of  service  all  the  rates  are 
highest  in  the  first  year,  and  gradually  diminish  thereafter,  to  rise 
again  aften  ten  years'  service.  The  death  rate  is  lowest  in  the  third 
or  fourth  year. 

The  influence  of  age  is  about  the  same  in  the  tropics  as  in  the 
United  States,  except  that  young  soldiers  are  still  more  liable  to 
swell  the  admission  rates.  The  lowest  rates  of  admission,  discharge 
and  non-effectiveness  are  among  soldiers  past  40,  although  it  is  this 
class  which  furnishes  the  highest  death  rate.  In  the  Philippines, 
the  admission  and  non-effective  rates  are  highest  in  the  first  and 
second  years  of  service,  and  then  gradually  diminish  until  ten  years 
or  more  or  service.  The  death  rate  is  high  during  the  first  year, 
then  falls  and  reaches  its  minimum  the  third  or  fourth  year,  there- 
after rising  and  reaching  its  maximum  after  ten  years  of  service  or 
45  years  of  age.  The  steady  fall  of  the  non-effective  rate  after  the 
second  year  of  service,  concurrently  with  the  steady  rise  of  the 
death  rate  after  the  third  or  fourth  year,  which  may  seem  puzzling, 
means  that  while  the  great  majority  of  the  men  become  hardier 
and  more  or  less  acclimatized,  a  small  proportion  (probably  less 
than  3  per  cent.)  gradually  lose  their  power  of  resistance  and  suc- 
cumb year  after  year  in  increasing  number. 

Influence  of  Climate  and  Station. 

Of  the  various  parts  of  the  United  States  and  its  colonies,  Alaska 
is  the  most  salubrious.  Thus  for  the  three  years  1908-1910,  its 
mean  rate  for  the  constantly  non-effective  from  disease  was  only 


MORBIDITY    AND    MORTALITY    IN    THE    MILITARY    SERVICE. 


21 


£ftf/z'e£3t'3'*'cs. 


y%a5?s^  .  -;g  ass 


/o 


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-30 


/  Z.o 


7.7"? 


FlG.  3.— Chart  showing  admission,  discharge,  death  and  non-effective  rates 
for  disease,  by  countries,  for  American  and  native  troops.     Year   1915. 


22  MILITARY    HYGIENE. 

10.7  per  thousand  strength,  while  it  was  32.4  in  the  United  States, 
39.4  in  Hawaii  and  45  in  the  Philippines. 

Fig.  3,  from  the  Surgeon  General's  Report  for  1915,  shows  the 
effect  of  climate  and  country  upon  American  and  native  troops ; 
from  it  it  appears  that  Alaska,  Hawaii  and  Porto  Rico  are  the 
healthiest  of  our  colonies,  and  that  all  three  have  better  rates  than 
the  United  States. 

Within  the  United  States  there  is  a  notable  difference  between  the 
health  records  of  the  nine  military  departments  into  which  its  terri- 
tory was  formerly  divided.  For  the  above  three  years,  the  Depart- 
ments of  the  Columbia  and  Texas  have  the  best  records,  closely 
followed  by  the  Department  of  California,  then  more  distantly 
by  the  Departments  of  Missouri,  the  Colorado,  the  East,  the 
Gulf,  Dakota  and  the  Lakes,  in  the  order  named.  Thus  the 
admission  rate  per  thousand  strength,  in  1910,  was  588  for  the 
Department  of  Columbia  and  979  for  that  of  the  Lakes.  Such 
disparity  is  the  more  remarkable  that  there  has  been  no  epidemic  or 
serious  endemic  outbreak  during  the  period  under  consideration, 
at  any  of  our  posts,  and  that  malarial  fever,  formerly  so  prevalent 
in  many  States,  has  ceased  to  be  an  important  factor  except  at  a 
very  few  posts,  none  of  which  are  in  the  two  Departments  reporting 
the  highest  morbidity.  Whatever  may  be  the  local  influences  which, 
added  to  the  peculiarities  of  climate,  bring  about  this  result  can  only 
be  a  matter  of  conjecture. 


CHAPTER    II. 

DISEASES    OF   THE    SOLDIEE. 

Soldiers  may  have  any  of  the  diseases  that  male  civilians  of  the 
same  age  suffer  from ;  they  possess  no  special  susceptibility  to,  nor 
immunity  against  them,  but  the  conditions  in  which  they  are  placed 
often  favor  the  occurrence  and  rapid  spread  of  certain  classes  of 
affections. 

Those  which  mostly  impair  the  efficiency  of  the  soldier  are  chiefly 
the  large  and  all-important  group  of  infectious  diseases ;  then,  sec- 
ondarily, those  caused  by  parasites,  exposure  to  inclement  weather 
and  extremes  of  temperature,  immoral  or  intemperate  habits,  and 
improper  diet. 

INFECTIOUS   DISEASES. 

The  lowest  class  (Tallophyta)  of  the  great  world  of  cryptogamic 
plants  is  made  up  of  algae,  lichens  and  fungi.  The  fungi,  including 
the  molds,  yeasts  and  bacteria,  are  of  most  interest  medically. 
Molds  and  yeasts  are  of  minor  importance  as  compared  with  bac- 
teria ;  they  cause  relatively  few  diseases  and  these  principally  of  the 
skin.  Molds  are  frequent  on  meats  and  other  foodstuffs,  while 
cheeses  depend  upon  them  for  their  flavors. 

Bacteria  are  very  minute  unicellular  organisms,  which  may  occur 
free  and  separate  or  else  in  groups  or  colonies.  They  are  divided 
into  three  main  classes:  the  cocci  or  spheres,  the  bacilli  or  straight 
rods  and  the  spirilla  or  curved  forms.  The  bacilli  are  by  far  the 
most  numerous ;  they  are  elongated  cells  from  two  to  ten  times 
longer  than  wide,  with  ends  squarely  cut  off  as  in  B.  anthracis,  or 
gently  rounded  as  in  B.  typhosus.  Many  bacilli  and  spirilla  are 
actively  motile  through  the  wavy  or  screw-like  motion  of  long 
tenuous  filaments  or  flagella. 

Bacteria  multiply  by  cell  division  or  fission.  The  cells  may 
divide  so  as  to  form  chains  (streptococci},  packets  or  cubes  (sar- 
cin&)  or  irregularly  in  various  directions  (micrococci}.  The  viru- 
lence of  streptococci  is  exceedingly  variable ;  in  long  chains  they  are 
commonly  the  cause  of  diffuse  phlegmonous  inflammation ;  in  short 
chains  they  are  often  the  normal  and  harmless  inhabitants  of  the 
mouth,  nose  and  intestines.  Micrococci  dividing  so  as  to  form 
masses  like  clusters  of  grapes  are  called  staphylococci,  of  which  the 

23 


24  MILITARY    HYGIENE. 

most  important  is  S.  pyogenes  aureus,  the  ordinary  cause  of  boils 
and  abscesses.  Micrococci,  after  division,  may  remain  coherent  in 
twos,  or  diplo-forms,  as  in  the  Pneumococcus,  Diplococcus  menin- 
qitidis  and  Gonococcus. 

The  spirilla  include  Spirillum  proper,  with  rigid  cells  and  polar 
tufts  of  flagella  (S.  of  cholera)  ;  Spirochocta,  with  sinuous,  flexible 
cells,  an  undulating  membrane  and  no  flagella  (S.  of  relapsing 
fever)  ;  and  Trcponema  which  differs  from  spirochaeta  in  having  a 
flagellum  at  each  end  and  no  undulating  membrane  (T.  of  syphilis 
and  yaws). 

Many  bacteria  possess  the  power  of  sporulation,  that  is,  to  de- 
velop into  an  encysted  stage  (spore)  for  the  purpose  of  resisting 
unfavorable  environment.  Of  this  class,  the  best  known  are  the 
bacilli  of  anthrax  and  of  tetanus. 

All  bacteria  need  oxygen  for  their  growth  and  multiplication. 
Those  requiring  it  in  the  free  state  are  called  aerobes;  those  for 
which  free  oxygen  is  injurious,  and  which  obtain  it  by  the  splitting 
of  carbohydrates  and  from  easily  deoxidized  bodies,  are  called 
anaerobes.  Between  these  two  classes  are  many  which  thrive  well 
under  either  condition ;  these  "  facultative  "  bacteria  include  most 
of  the  parasitic  and  saprophytic  kinds. 

According  to  their  action  upon  the  higher  animals,  bacteria  are 
divided  into  parasites  or  those  capable  of  living  and  multiplying 
within  the  human  or  other  animal  bodies,  and  saprophytes  or  those 
which  are  unable  to  maintain  themselves  in  tissues  of  the  higher 
animals  but  swarm  everywhere  in  air,  soil  and  water,  being  con- 
cerned in  many  biological  processes  beneficial  to.  animals  and  plants. 
The  separation  between  these  two  classes  is  not  sharply  drawn; 
many  bacteria  are  capable  of  developing  under  both  conditions, 
although  seldom  equally  well ;  some  of  the  pathogenic  varieties 
belong  to  these  so-called  facultative  parasites. 

Diseases  caused  by  the  introduction  of  virulent  microorganisms 
into  the  tissues  of  the  body  are  called  infectious.  Among  them  are 
the  most  common  and  dreaded  disorders  from  which  troops  suffer 
in  peace  and  war,  and  nearly  all  the  mortality  results.  The  epithet 
pathogenic  (disease  producing)  is  commonly  applied  to  all  organ- 
isms which  thus  transmit  infections.  Pathogenic  microorganisms 
are  of  two  kinds,  the  microbes  or  bacteria  above  described,  and 
Protozoa,  the  lowest  unicellular  forms  of  animal  life.  Most  of 


DISEASES    OF   THE   SOLDIER.  25 

them  are  visible  under  the  microscope;  others  are  ultramicroscopic 
and  therefore  invisible,  their  existence,  as  in  yellow  fever,  small- 
pox, etc.,  being  postulated  from  analogy  with  other  diseases  in  which 
the  causative  organisms  are  well  known.  Both  kinds,  bacteria  and 
protozoa,  may  produce  infectious  diseases,  that  is,  diseases  com- 
municable from  man  to  man.  The  mode  of  conveyance  is  not 
always  clear.  The  former  faith  in  fomites  infection  (the  transmis- 
sion of  long-persistent  germs  through  clothing  and  bedding)  or  in 
aerial  infection  (the  transmission  of  more  or  less  desiccated  germs 
considerable  distances  through  the  air),  is  now  mostly  discredited 
and  replaced  by  belief  in  actual  contact,  direct  or  indirect,  with  com- 
paratively fresh  organisms.  Fliigge  and  his  pupils  have  laid  great 
stress  upon  the  spray  thrown  out  from  the  mouth  in  coughing,  sneez- 
ing and  loud  speaking  as  a  possible  factor  in  the  spread  of  tuber- 
culosis and  other  diseases  whose  germs  inhabit  the  naso-pharyngeal 
cavities.  From  the  result  of  careful  experiments,  Winslow  and 
Robinson*  were  unable  to  confirm  Fliigge's  teaching,  and  sum  up 
their  conclusions  as  follows :  "  It  appears  from  these  investigations 
that  spray  is  discharged  from  the  mouth  during  loud  speaking  in 
such  amount  as  to  cause  a  considerable  pollution  of  exposed  sur- 
faces upon  which  it  falls.  True  aerial  pollution  by  particles  sus- 
pended in  the  air  and  liable  to  be  inhaled  with  it,  is  on  the  other 
hand  so  slight  that  it  can  hardly  play  a  relatively  important  part  in 
the  causation  of  disease." 

This  contact  of  infectious  organisms  is  obvious  and  admitted  in 
typhoid  fever  and  other  fecal-borne  diseases  such  as  cholera,  dysen- 
tery and  diarrhea.  It  is  still  more  evident  and  direct  in  those  dis- 
eases in  which  the  infective  agent  is  contained  in  the  secretions  of 
the  mouth  and  nose,  as  in  diphtheria,  pneumonia,  whooping-cough, 
tuberculosis,  influenza  and  cerebrospinal  meningitis.  According  to 
Chapin,  there  is  every  reason  to  believe  that  even  small-pox,  scarlet 
fever  and  measles  are  not  contracted  otherwise  than  by  contact. 

Germs  may  be  conveyed  in  ways  that  are  obscure  and  difficult  of 
detection,  for  instance  by  the  patient  himself  when,  being  only 
mildly  sick  and  unaware  of  the  nature  of  his  illness,  he  continues  to 
attend  to  his  usual  avocations.  Another  common  factor  of  con- 
veyance is  by  carriers.  There  are,  of  course,  men  who  through 
their  soiled  hands  and  clothing  and  uncleanly  habits  carry  germs 

*  Am.  J.  Pub.  Hyg.,  1910. 


26  MILITARY    HYGIENE. 

from  the  sick  to  the  well  or  infect  the  food  and  drink  of  healthy 
people;  but  the  term  carrier  is  here  specifically  applied  to  the  men 
and  women  (common  carriers)  who  after  recovering-  from  an 
infectious  disease  continue  to  discharge  pathogenic  germs  for  some 
weeks  or  months  afterwards,  or  to  men  and  women  (contact  car- 
riers) who  become  infected  by  contact  with  patients  and  carry  germs 
in  their  secretions  or  excretions,  but  remain  in  normal  health  and 
show  no  clinical  symptoms  of  the  disease  so  that  they  may  be  active 
propagators  of  it  for  indefinite  periods  before  they  are  suspected. 

From  what  has  been  said  it  follows  that  the  two  terms,  con- 
tagious and  infectious,  have  lost  their  former  distinctive  significance 
and  are  practically  synonymous. 

The  production  of  infection,  in  man,  is  a  complex  process,  requir- 
ing other  factors  than  the  mere  contact  of  pathogenic  organisms. 
These  must  have  the  required  degree  of  virulence,  gain  entrance  to 
the  tissues  of  the  body  in  sufficient  number  and  possess  the  ability 
to  live  and  multiply  in  them.  It  is  well  known  that  most  pathogenic 
bacteria  may  be  found  in  the  body  in  a  quiescent  or  latent  state  and 
without  ill  effects ;  thus  staphylococcus,  streptococcus,  pneumococ- 
cus  and  various  spirilla  are  always,  and  the  germs  of  diphtheria  and 
cerebrospinal  meningitis  often,  present  in  the  mouth,  nose  and 
throat ;  the  colon  organisms  are  invariably  found  in  the  normal 
bowel,  while  the  tubercle  bacillus  is  a  frequent  inhabitant  of  the 
lymphatic  glands  of  healthy  subjects.  The  influences  which  may 
suddenly  light  these  parasites  into  toxic  activity  are  still  conjec- 
tural. In  this  connection  the  doctrine  of  autogenesis  suggested  by 
Pasteur  and  developed  by  Kelsh  and  other  French  epidemiologists, 
possesses  plausibility.  It  claims  that  the  virulence  of  germs  is  a 
variable  quantity,  absent  or  dormant  for  indefinite  periods  of  time, 
but  capable  of  manifesting  itself  under  the  influence  of  cosmic  or 
other  extrinsic  unknown  factors.  It  does  not  deny  the  possibility 
and  frequency  of  contagion,  but  limits  its  range  of  action.  Thus 
would  be  explained,  for  instance,  the  presence  of  typhoid  cases  in 
isolated  places,  away  from  sources  of  infection,  or  the  apparently 
spontaneous  breaking  out  of  diseases  such  as  cerebrospinal  men- 
ingitis, influenza,  cholera,  in  endemic  or  epidemic  forms,  sometimes 
simultaneously  in  various  disconnected  foci. 

The  effect  of  weakening  or  depressing  influences  on  the  develop- 
ment of  infectious  diseases  is  well  known;  it  explains  the  paroxism 


DISEASES    OF    THE    SOLDIER.  2/ 

of  intermittent  fever  which  follows  a  cold  bath,  or  the  attack  of 
dysentery  which  results  from  exposure  to  wet  and  cold.  Calmelte, 
Granjux  ana  other  sanitary  authorities  in  the  French  Army  assert 
positively  that  maneuvers  or  campaigning  involving  great  fatigue, 
whether  at  home  or  in  African  deserts,  are  always  followed  by  an 
outbreak  of  typhoid  fever,  independently  of  any  infective  cause 
other  than  the  latent  germs  carried  in  the  system. 

Against  the  invasion  of  microorganisms  the  body  is  guarded 
externally  by  the  skin  and  mucous  membranes.  They  may  pass 
readily  into  the  system  through  any  cut,  break  or  ulceration  of  the 
cuticle  (as  in  plague  and  tetanus),  while  others  are  directly  injected 
by  stinging  insects  (as  in  yellow  fever  and  malaria).  Many  are 
absorbed  through  the  naso-pharynx  or  perhaps  the  respiratory  tract 
(as  in  influenza,  diphtheria,  tuberculosis,  pneumonia,  etc.),  and 
through  the  alimentary  canal  (as  in  typhoid  fever,  cholera  and 
dysentery). 

Bacteria  may  do  harm  to  the  tissues  by  mechanical  interference, 
but  their  chief  injurious  action  is  through  the  poisons  or  toxins 
which  they  produce.  These  poisons  may  be  true  toxins,  that  is  real 
secretions  of  the  bacterial  cells,  soluble  and  readily  diffused  in  the 
blood  (as  in  diphtheria,  tetanus  and  botulism),  or  they  may  remain 
within  the  bacterial  body,  separating  from  it  only  after  its  death 
and  disintegration ;  these  are  the  endoto.vins  and  are  produced  by 
the  greater  number  of  pathogenic  bacteria  (in  typhoid  fever,  cholera, 
plague,  etc.). 

The  presence  of  toxins  in  the  blood  determines  the  prompt 
formation  of  antidotes  or  antitoxins,  a  reaction  taking  place 
between  the  two,  analogous  to  the  chemical  neutralization  of  an  acid 
by  a  base.  The  system  is  also  protected  by  various  agents  or  anti- 
bodies making  up  its  defensive  or  resistance  power;  they  normally 
exist  in  the  tissues  and  are  increased  through  the  stimulation  of  the 
invading  organisms  and  their  products,  reaching  their  full  develop- 
ment when  immunity  is  acquired.  Some  of  them  (lysins)  disin- 
tegrate and  dissolve  the  bacteria;  others  (ayglutinins)  cause  the 
latter  to  lose  motility  and  clump*  together ;  others  again  (opsonins) 
facilitate  their  destruction  by  the  leucocytes. 

Another  and  very  important  protective  agency  is  phagocytosis, 
the  power  which  certain  cells  possess  of  ingesting  and  destroying 
bacteria.  These  phagocytic  cells  are  blood  leucocytes  and  certain 


28  MILITARY    HYGIENE. 

large  endothelial  cells  lining  serous  cavities  and  blood  vessels.  The 
leucocytes  most  concerned  are  the  polymorphonuclear  cells  (micro- 
phages)  and  the  large  mononuclear  cells  (macro  phages).  The 
degree  of  resistance  to  any  infection  seems  to  be  proportionate  to 
the  activity  of  these  devouring  cells,  and  Metchnikoff  believes  that 
phagocytosis  is  the  cardinal  factor  which  determines  immunity ; 
other  investigators,  however,  contend  that  the  struggle  takes  place 
in  the  fluids  of  the  body  and  that  phagocytosis  is  merely  a  means 
of  removing  dead  or  inactive  bacteria.  It  has  been  established  that 
phagocytosis  is  very  much  increased  by  certain  special  substances 
contained  in  immune  serum.  These  substances,  the  opsonins  of 
Wright,  act  directly  upon  the  bacteria,  facilitating  their  ingestion 
and  destruction  by  the  leucocytes.  They  appear  to  be  identical  with 
the  opsonins  existing  in  normal  blood.  The  effect  of  phagocytosis 
upon  protozoa,  although  not  yet  thoroughly  understood,  is  probably 
also  well  marked. 

IMMUNITY. —  Immunity  against  infectious  aiseases  may  be  nat- 
ural or  acquired;  natural  when  it  is  the  normal  attribute  of  a  race, 
species  or  individual ;  acquired  when  obtained  either  accidentally  or 
artificially.  A  first  attack  of  most  infectious  diseases  so  strengthens 
the  resistance  of  the  individual  that  he  is  no  longer  susceptible  to 
the  same  infections.  This  is  natural  acquired  immunity.  The  pro- 
tection conferred  by  the  inoculation  of  gradually  increasing  doses 
of  toxin,  or  of  dead  bacteria  with  their  liberated  endotoxins,  inas- 
much as  it  depends  upon  the  reactions  of  the  tissues  of  the  subject 
inoculated,  is  spoken  of  as  active  immunity.  After  animals  have 
been  actively  immunized  against  toxins,  their  sera,  rich  in  antitoxins, 
are  capable  of  protecting  man  against  the  corresponding  infections. 
The  resistance  thus  acquired,  as  for  instance  by  the  inoculation  of 
diphtheria  antitoxin,  is  a  purely  passive  process  and  is  known  as 
passive  immunity. 

The  study  of  immunity  against  diseases  caused  by  pathogenic 
protozoa  has  as  yet  produced  no  practical  result.  From  present 
indications  it  is  probable  that  it  will  be  found  easier  to  abolish  the 
etiological  factors,  especially  in  the  case  of  infections  known  to  be 
transmitted  through  the  sting  or  bite  of  insects.  A  certain  degree 
of  individual  immunity  is  naturally  acquired  against  malaria  by  a 
long  residence  in  malarial  regions,  but  such  immunity  is  probably 
never  inherited.  Inasmuch  as  the  natives  of  countries  in  which 


DISEASES    OF   THE   SOLDIER.  2Q 

yellow  fever  (an  assumed  protozoal  infection)  is  endemic  rarely 
suffer  from  this  disease,  it  was  formerly  supposed  that  they  enjoyed 
a  natural  immunity  against  it,  but  Guiteras  has  shown  that  it  was 
an  acquired  immunity  conferred  by  a  mild  attack  in  infancy.  Mar- 
chaux  and  Simond  claim  to  have  produced  relative  immunity  against 
yellow  fever  by  injections  of  the  serum  of  convalescents. 

TYPHOID  FEVER. 

Writing  in  1905,  Kean  could  truthfully  say  that  "  Typhoid  fever 
is  to-day,  on  account  of  its  wide  dissemination,  the  persistent  vitality 
of  the  infecting  organism,  the  duration  and  severity  of  its  attack 
and  its  large  death  rate  the  most  formidable  infectious  disease  with 
which  we  have  to  contend  in  military  life."  Since  then  antityphoid 
vaccination  has  been  extensively  practised  and  found  to  be  a 
wonderful  prophylactic  weapon  in  the  hands  of  medical  officers. 
Nevertheless,  for  the  reasons  stated,  as  well  as  on  account  of  its 
ready  transmission  from  man  to  man  by  direct  or  indirect  contact, 
and  the  marked  susceptibility  of  the  American  people  to  its  infec- 
tion, typhoid  fever  will  doubtless  continue  to  be  one  of  the  most 
dangerous  diseases  of  military  life. 

In  garrisons,  typhoid  fever  is  easily  controlled,  but  in  large  camps, 
where  troops  assemble  for  instruction  or  mobilization,  or  in  the 
field  during  active  service,  it  is  a  very  different  matter  because  of 
the  difficulty  of  disposing  of  the  excretions  from  the  human  body. 
During  the  Civil  War  the  rate  of  admissions  was  62  per  1,000  of 
strength,  a  rate  which  has  since  been  exceeded  in  several  wars. 
Typhoid  fever  being  endemic  throughout  the  United  States,  it  is 
hardly  possible  for  any  volunteer  regiment,  often  made  up  of  units 
from  different  localities,  to  come  to  such  camps  without  bringing 
one  or  more  cases  in  the  period  of  incubation,  or  already  developed. 
Such  primary  cases  are  inevitable ;  every  new  batch  of  recruits  may 
contain  some ;  they  should  be  expected  and  watched  for.  But  sec- 
ondary cases,  that  is,  cases  infected  by  the  primary  ones,  are  pre- 
ventable and  their  occurrence  will  justify  the  assumption  of  imper- 
fect or  careless  prophylaxis. 

Typhoid  fever,  as  seen  in  camps,  assumes  many  types,  some  of 
which  vary  widely  from  the  classic  form  and  have  only  been  identi- 
fied by  the  improved  diagnostic  methods  of  recent  years.  The 


3O  MILITARY    HYGIENE. 

elaborate  report  of  the  Reed  Board*  appointed  to  investigate  the 
typhoid  fever  epidemic  of  the  military  camps  in  the  United  States, 
in  1898,  threw  much  instructive  light  upon  the  subject.  The  mem- 
bers of  this  board  by  studying  the  medical  histories,  company  by 
company,  in  106  regiments,  found  that,  besides  the  cases  clearly 
typhoid,  there  were  many  others  of  a  few  days  duration  only,  diag- 
nosed malarial,  which  were  no  longer  susceptible  to  the  infection  of 
typhoid.  They  also  found  that  previous  attacks  of  diarrhea  and 
gastro-enteritis  were  likewise  in  a  large  measure  protective.  Hence 
their  conclusion  that,  during  the  prevalence  of  an  epidemic  of  typhoid 
fever,  many  of  the  cases  heretofore  diagnosed  malarial  fever  or 
diarrhea  are  really  mild  and  atypical  forms  of  typhoid,  insuring 
protection  against  that  disease  and  quite  as  capable  of  conveying 
its  infection  as  the  gravest  forms.  According  to  this  expert  Board, 
hardly  one-half  of  the  cases  of  typhoid  were  diagnosed  as  such,  and 
the  rate  of  admissions  which  was  reported  as  88.55  Per  thousand 
strength  should  have  been  192.65.  Long  before  this  it  had  been 
known  that  the  so-called  typho-malarial  fever  of  the  Civil  War  was 
simply  typhoid  with  or  without  malarial  complication.  The  obser- 
vations of  the  Board  "  appear  to  indicate  that  when  an  individual, 
the  subject  of  malaria,  is  subsequently  infected  by  the  typhoid  bacil- 
lus, the  manifestations  of  the  malarial  parasite  remain,  as  a  rule, 
in  abeyance  during  the  active  stage  of  the  typhoid  infection,  to 
appear,  in  a  certain  proportion  of  cases,  during  the  stage  of  debility 
attendant  upon  the  convalescence."  The  term  typho-malarial,  denot- 
ing a  hybrid  form  of  disease,  is  therefore  misleading  and  should 
be  dropped  from  the  nomenclature. 

Typhoid  Bacillus. —  The  specific  organism,  cause  of  typhoid  fever, 
is  the  Bacillus  typhosus,  a  short,  flagellated,  sporeless  bacterium 
closely  resembling  the  widespread  Bacillus  coli  communis  and  often 
hard  to  distinguish  from  it.  It  flourishes  best  at  the  temperature  of 
the  body  and  ceases  to  grow  below  48°  or  above  108°  F.  It  is 
quickly  killed  in  boiling  water,  or  when  exposed  for  15  minutes  to 
a  temperature  of  140°.  The  most  intense  cold  yet  produced  does 
not  destroy  it,  and  it  may  remain  frozen  in  ice  for  months  without 
appreciable  loss  in  virulence.  It  may  retain  its  vitality  for  a  while 

*  Consisting  of  Major  Walter  Reed,  Surgeon,  U.  S.  Army;  Major  Victor  C. 
Vaughan,  Division  Surgeon,  U.  S.  V.;  and  Major  Edward  O.  Shakespeare, 
Brigade  Surgeon,  U.  S.  V. 


MILITARY  HYGIENE — HAVARD 


PLATE  I 


• 


1.  Diplococcus  lanccolatus  (pneumonia)  in  blood  of  rabbit. 

2.  Bacillus  of  tuberculosis  in  sputum. 

3.  Bacillus  of  influenza  in  pure  culture. 

4.  Bacillus  of  diphtheria  in  pure  culture. 

5-  Bacillus  of  typhoid  fever  in  pure  culture. 

6.  Bacillus  of  Asiatic  cholera  in  pure  culture. 


DISEASES    01'    THK    SOLDIER.  3! 

in  very  dry  material  but  complete  desiccation  soon  kills  it.  It  may 
live  and  breed  for  a  long  time  in  earth  contaminated  with  organic 
matter,  but  soon  dies  out  in  clean  soil  well  exposed  to  the  sun.  In 
distilled  water  it  may  live  for  two  or  three  months,  but  in  ordinary 
water  its  life  is  generally  shortened  to  one  or  two  weeks  and  often 
to  three  days  (E.  O.  Jordan)  by  competition  with  saprophytic  bac- 
teria. In  sewage,  it  tends  rather  to  decrease  than  to  multiply,  and 
seldom  survives  48  hours  in  fecal  matter.  Experiments  with  pure 
cultures  seem  to  show  that,  in  the  soil,  it  may  survive  one  or  two 
months  and  thus  might,  during  this  period,  infect  the  streams  drain- 
ing the  contaminated  area.  But  Morgan  and  Harvey  have  demon- 
strated that  the  results  are  very  different  under  natural  conditions, 
in  which  this  bacillus  is  associated  with  and  vastly  outnumbered  by 
antagonistic  organisms ;  then  its  life  duration  is  very  short,  seldom 
exceeding  two  or  three  days.  In  clothing  and  tentage,  this  organism 
may  survive  several  weeks  and  be  carried  long  distances,  thus  pro- 
ducing fresh  outbreaks  in  unexpected  places. 

The  average  incubation  period  is  8-12  days,  but  the  interval 
between  exposure  and  the  outbreak  of  the  fever  may  be  much 
greater.  One  may  carry  the  bacilli  under  his  nails,  in  his  hair  or 
on  his  clothing  for  some  days,  possibly  for  weeks,  before  they  find 
their  way  into  the  alimentary  canal. 

The  typhoid  bacillus  is  passed  in  vast  numbers  w7ith  the  feces  of 
the  patients  from  the  beginning  of  the  disease,  sometimes  from  the 
stage  of  incubation,  and  often  continues  to  be  discharged  long  after 
convalescence  has  set  in.  It  is  also  passed  in  the  urine  in  about 
one-fourth  of  all  cases,  often  in  enormous  numbers,  as  if  in  pure 
culture,  so  that  a  drop  may  contain  millions.  "  Because  of  the 
frequency  with  which  it  is  voided,  its  comparative  inoffensiveness, 
its  easy  dissemination  and  the  relatively  great  number  of  organisms 
present,  infected  urine  is  the  most  dangerous  excretion  of  the 
typhoid  patient"  (Vanghan}.  Other  secretions,  such  as  sweat, 
saliva  and  milk,  may  also  contain  the  organism. 

A  large  proportion  of  patients  continue  to  excrete  bacilli  in  their 
feces  after  the  disappearance  of  all  febrile  symptoms.  This  pro- 
portion falls  to  about  4  per  cent,  ten  weeks  from  the  beginning  of 
the  fever  (Lents'),  and  to  2-3  per  cent,  a  year  afterward.  These 
are  the  common  typhoid  carriers:  most  of  them  discharge  virulent 
bacilli  for  years  and  some  throughout  their  lives.  Another  class  of 


32  MILITARY    HYGIENE. 

carriers,  designated  contact  carriers,  consist  of  healthy  individuals 
who  give  no  history  of  ever  having  had  typhoid  fever ;  they  amount 
to  about  3  per  1,000  of  the  adult  population.  It  is  generally 
assumed,  however,  that  these  contact  carriers  have  at  some  time  suf- 
fered from  a  mild  attack,  overlooked  or  forgotten.  In  all  carriers 
the  germs  are  generated  chiefly  in  the  gall-bladder  and  often  become 
the  cause  of  cholecystitis  and  gall-stones.  In  the  relatively  rare 
urinary  carriers,  the  germs  are  generated  in  the  bladder,  pelvis  or 
kidney,  producing  a  chronic  inflammation  of  these  organs.  It 
should  be  noted  that  carriers  discharge  germs  more  or  less  inter- 
mittently, the  excreta,  at  times,  being  free  from  them  for  several 
days;  therefore  suspected  persons  should  be  subjected  to  at  least 
two  examinations,  a  few  days  apart,  before  being  declared  free 
from  infection. 

Safety  then  requires  that,  in  camp,  all  excreta  should  be  con- 
sidered infected.  The  soldier  may  be  readily  convinced  of  the 
danger  of  fecal  matter,  but  it  will  require  special  efforts  on  the  part 
of  his  officers  to  make  him  realize  that  urine  is  equally  dangerous 
and  must  be  disposed  of  with  the  same  care. 

Dissemination. —  Typhoid  fever,  as  a  general  rule,  is  spread  only 
by  the  introduction  of  the  specific  organism  into  the  alimentary 
canal  with  food  or  drink;  in  other  words,  by  the  ingesting  of 
infected  food  or  the  drinking  of  polluted  liquid.  Fecal  matter  and 
urine  being  the  infectious  media,  it  is  important  to  know  how  they 
are  transmitted  and  disseminated.  Man  himself  is  the  most  active 
agent  in  this  dissemination,  for  he  may  carry  them  in  his  alimentary 
canal  and  bladder,  on  his  person  or  clothing,  hundreds  and  thou- 
sands of  miles.  As  stated  before,  at  least  one  man  in  every  regi- 
ment of  volunteers  can  be  assumed  to  be  infected  before  he  reaches 
the  camp  of  mobilization,  and,  as  he  usually  discharges  virulent 
germs  during  the  stage  of  incubation  and  before  showing  any  visible 
clinical  signs  of  infection,  he  may  plant  the  typhoid  bacillus  in  every 
latrine  in  his  regiment  before  being  suspected  and  removed.  In 
each  regiment  there  will  be  also  one  or  more  chronic  carriers, 
unconsciously  discharging  highly  infective  stools.  Finally,  it  is  not 
uncommon  to  find  men  with  such  a  mild,  atypical  form  of  the  fever 
(ambulant  cases)  that  they  remain  on  duty,  a  constant  menace  to 
their  unsuspecting  comrades.  It  follows  that,  in  a  military  camp, 
all  excreta  must  be  considered  infected.  This  infection  is  not  a 


DISEASES    OF   THE    SOLDIER.  33 

mere    possible   contingency,    but    a    very    probable    if    not    certain 
condition. 

The  most  common  and  widespread  mode  of  transmission  in  camp 
is  that  which  takes  place  by  contact.  Dried  fecal  matter  and  urine 
may  be  carried  on  the  hands,  shoes,  clothing  and  skin  of  patients  in 
the  incubative  stage,  of  chronic  carriers  and  ambulant  cases,  and, 
in  the  close  intercourse  of  tent  life,  propagated  from  man  to  man 
and  from  man  to  food,  before  the  responsible  individuals  are 
detected  and  isolated.  Should  typhoid  patients  be  taken  care  of  in 
a  regimental  infirmary  instead  of  being  promptly  removed  to  a  field 
hospital,  there  would  be  the  additional  danger  of  propagation  by 
nurses  and  visiting  comrades. 

It  is  mostly  by  contact  that  the  disease  is  spread  through  a  family 
after  its  introduction,  and  it  is  doubtless  one  of  the  chief  modes  of 
its  propagation  in  the  field.  This  was  well  demonstrated  in  some 
of  our  camps  during  the  Spanish- American  War,  in  1898,  where 
the  fever  was  characterized  by  a  series  of  company  epidemics,  with 
a  traceable  connection  in  each  company  between  two-thirds  of  the 
cases;  thus  certain  tents  were  badly  infected  and  the  majority  of 
their  inmates  developed  the  disease,  while  adjoining  tents  wholly 
escaped.  The  influence  of  contact  was  also  clearly  shown  in  a  camp 
of  Boer  prisoners  in  the  hills  of  Ceylon,  in  1901,  where  over  5,000 
men  were  collected.  The  site  was  high  and  the  water  supply  good, 
"  The  camp  was  free  of  disease  until  typhoid  fever  was-  introduced 
by  some  newly  arrived  prisoners.  Within  three  months  there  were 
over  700  cases  among  the  prisoners.  The  troops  guarding  them, 
who  were  under  practically  identical  conditions  as  regards  food  and 
water,  escaped  entirely"  (Thomas  McCrae}.  It  is  very  probable 
that  the  typhoid  fever  epidemic  among  the  British  troops  at  Bloem- 
fontein  (1900),  attributed  to  an  infected  water  supply,  was  also 
mostly  due  to  contact  infection. 

A  careful  investigation  of  the  causes  of  the  high  rates  of  typhoid 
fever  in  Washington,  D.  C.,  for  the  period  1906-1911,  led  to  the 
conclusions  that  "  contacts  and  carriers  "  were  the  predominant  fac- 
tors in  the  spread  of  the  infection. 

Contact  infection  may  be  more  or  less  indirect,  as,  for  instance, 
when  effected  through  tentage,  bedding  or  clothing.  Probably  in 
this  way  was  typhoid  fever  carried  from  Fort  Snelling,  Minn.,  to 
Camp  Columbia,  Cuba,  in  1906,  and  thence  to  several  posts  on  the 


34  MILITARY    HYGIENE. 

Island.  Therefore  it  is  important  that  canvas  and  all  other  fabrics 
which  have  been  exposed  should  be  thoroughly  fumigated  before 
being  packed  and  shipped  away;  when  unpacked  it  will  be  a  wise 
precaution  to  spread  them  out  in  the  sun.  Another  illustration  of 
indirect  contact  is  that  furnished  by  company  pets,  mostly  dogs  and 
cats,  with  retentive  and  absorbing  furs,  caressed  alike  by  hands 
that  infect  and  hands  that  become  infected. 

In  civil  life,  the  great  epidemics  of  typhoid  fever  are  generally 
caused  by  the  specific  contamination  of  drinking  water.  In  gar- 
rison or  permanent  camp  the  water  supply  is  mostly  obtained  from 
deep  wells,  piped  from  wholesome  sources,  or  else  purified  so  as  to 
be  above  suspicion.  In  the  military  camps  of  1898,  infected  water 
was  not  an  important  factor  in  the  spread  of  typhoid  fever.  It  is 
very  important  that  the  men  should  be  required  to  use  only  water 
and  other  beverages  from  authorized  sources ;  there  is  real  danger, 
for  instance,  from  the  unwholesome  preparations  of  the  numerous 
vendors  of  soft  drinks  always  found  in  the  vicinity  of  camps  and 
garrisons. 

Milk  is  a  common  vehicle  of  bacteria  and  responsible  for  a  con- 
siderable proportion  of  typhoid  fever  cases.  It  is  infected  indi- 
rectly through  the  water  used  to  dilute  it  or  wash  the  dairy  uten- 
sils, or  else  directly  through  the  unclean  hands  of  the  milkers  and 
bottlers.  Milk  products  retain  most  of  the  bacilli  present  in  the 
milk  and  may  also  be  more  or  less  infected.  Ice-cream  is  the  most 
dangerous. 

Of  articles  of  food  known  to  be  occasional  vehicles  of  the  typhoid 
bacillus  should  be  mentioned  oysters  and  clams  in  the  raw  state 
(see  Mollusks),  as  well  as  fruits  and  vegetables  uncooked,  espe- 
cially when  much  handled  and  long  exposed  to  fly  pollution.  Wher- 
ever the  soil  is  fertilized  with  sewage,  there  is  danger  of  the  plants 
growing  in  it  becoming  infected;  if  not  cooked  (lettuce,  celery, 
etc.),  they  should  be  carefully  washed  before  consumption. 

Bathing  in  infected  water,  fresh  or  salt,  is  not  without  danger 
and  should  be  avoided,  for  the  organisms  may  enter  the  system 
through  the  mouth,  nose  and  eyes. 

Flies, —  Flies  are  known  to  be  one  of  the  chief  factors  in  the  dis- 
semination of  typhoid  fever.  In  several  of  our  encampments,  in 
1898,  they  were  the  most  active  agents  in  the  spread  of  this  disease. 
The  reasons  given  by  the  Reed  Board  for  coming  to  this  conclusion 
were  as  follows: 


DISEASES    OF   THE   SOLDIER.  35 

1.  The  latrines  contained  infected  fecal  matter. 

2.  Flies  alternately  visited  and  fed  upon  this  infected  fecal  matter 
and  the  food  in  the  mess-tents. 

3.  Typhoid   fever  was  much  less   frequent  among  members  of 
messes  who  had  their  mess-tents  screened  than  among  those  who 
took  no  such  precaution. 

4.  The  fever  gradually  died  out,  in  the  fall  of   1898,  with  the 
disappearance  of  flies,  and  this  at  a  time  when  in  civil  life  it  is 
generally  on  the  increase. 

Fecal  matter  adheres  readily  to  the  feet  and  proboscis  of  flies 
and  may  be  carried,  not  only  from  latrines  but  also  from  soiled 
clothing,  bedding  or  bed  pans,  to  kitchens  and  mess-tents  where  it 
is  deposited  on  food  or  in  drink;  or  else  it  may  be  carried  to  the 
men's  tents  where  it  is  deposited  upon  their  persons  or  clothing. 
It  is  also  known  that  the  excrements  of  flies  that  have  fed  on 
infected  feces  contain  the  typhoid  bacillus.  (See  Flies,  page  152.) 

It  has  been  reported  that'  in  some  of  the  typhoid  outbreaks  in 
English  garrisons,  the  cavalry  suffered  more  than  the  infantry,  on 
account,  it  is  presumed,  of  the  greater  number  of  flies  in  the 
cavalry  quarters. 

Grave  as  is  the  danger  of  fly  transmission  in  camp  and  under 
rural  conditions,  it  does  not  seem  to  play  an  important  part  in  the 
production  of  typhoid  fever  in  cities.  According  to  C.  V.  Chapin 
"  there  is  no  evidence  that  in  the  average  city  the  house-fly  is  a 
factor  of  great  moment  in  the  dissemination  of  disease.  In  a  rea- 
sonably clean  and  well-sewered  city,  the  cases  of  typhoid  due  to  fly 
transmission  are  relatively  very  few  compared  with  the  numbers 
due  to  water,  milk  and  contact." 

As  already  stated,  the  soil  becomes  readily  infected  with  the 
typhoid  germ  when  fouled  with  feces  or  urine  and  may  therefore 
be  a  means  of  transmitting  the  disease.  This  takes  place  when  it 
dries  up  and,  with  the  dust,  is  blown  in  drinking  water,  on  food, 
clothing  or  any  object  handled  by  the  men.  Fortunately,  it  is  likely 
that  the  specific  organism,  when  thus  mixed  with  dust,  soon  becomes 
desiccated  and  devitalized. 

As  before  mentioned  (page  26),  French  military  hygienists  lay 
some  stress  on  the  alleged  effect  of  prolonged  physical  strain  in 
bringing  about  outbreaks  of  typhoid  fever.  Thus  they  contend  that 
a  large  increase  of  cases  is  always  noticed  right  after  the  fall 
maneuvers  in  the  French  and  German  armies,  as  well  as  during 


MILITARY    HYGIENE. 


arduous  campaigns.  For  believers  in  autogenesis  this  is  a  natural 
corollary  of  the  doctrine.  Others  may  argue  that  inasmuch  as  the 
maneuvers  usually  take  place  during  the  season  when  typhoid  fever 
is  most  prevalent,  an  increase  of  cases  in  the  operating  troops  might 
be  reasonably  expected. 

Statistics. —  Typhoid  fever  in  the  U.  S.  Army  has  steadily 
declined  since  the  Spanish-American  War.  (Fig.  "4.)  In  1899, 
the  rates  per  1,000  of  strength,  for  the  United  States  proper,  were 
10.85  °f  admissions  and  1.07  of  deaths.  During  the  years  1904- 
1906,  they  were  4.95  and  0.28  respectively.  In  1910,  they  had  fallen 


t?°3 


// 


FIG.  4. —  Chart  showing  admission,  and  death   rates   for  typhoid  arid  para- 
typhoid fevers  in  U.  S.  Army.     (From  A.  G.  Love,  U.  S.  Army.) 

to  2.32  and  0.16;  and  in  1911,  to  0.76  and  o.io.  In  1912,  the  rate  of 
mortality  was  only  0.03,  almost  a  negligible  quantity.  During  the 
four  years  1909-1912  no  death  occurred  among  vaccinated  soldiers 
in  the  United  States.  This  remarkable  decline  in  the  curves  of 
morbidity  and  mortality  is  the  normal  result  of  our  better  knowl- 
edge of  the  principles  of  phophylaxis  and  of  greater  care  in  apply- 
ing them,  as  well  as  the  effect  of  the  process  of  immunization  by 
vaccination.  In  the  U.  S.  Navy  and  Marine  Corps,  the  rates  for 
the  years  1909  and  1910  were  3.30  for  admission  and  0.23  for 
deaths.  Since  then  prophylaxis  by  vaccination  has  also  been  made 
compulsory  so  that  for  the  two  years  1914  and  1915  there  were 
only  31  admissions  and  one  death. 

Until  three  or  four  years  ago,  our  Army  rates  for  typhoid  fever 
were  higher  than  in  most  European  armies,  but  it  is  gratifying  to 


DISEASES    OF    THE    SOLDIER.  37 

note  that  we  have  recently  progressed  at  a  more  rapid  pace  and 
that  our  rates  (for  1911  and  1912)  have  fallen  below  those  of 
foreign  armies. 

The  report  of  the  United  States  Census  Office  and  that  of  the 
Registrar  General  of  England  and  Wales,  for  the  years  1901-1905, 
show  that  the  mortality  rate  of  typhoid  fever  in  the  United  States 
is  far  in  excess  of  that  of  most  European  countries.  Thus  while 
this  rate  was  32.2  per  100,000  of  population  in  the  United  States, 
it  was  only  11.2  in  England  and  Wales,  7.5  in  Germany,  11.4  in 
Japan  and  5.7  in  Norway.  The  rate  for  France  is  not  available. 
During  about  the  same  period,  it  was  16.2  in  New  York,  24.7  in 
Albany,  27.8  in  Boston,  29.8  in  Chicago  and  44.2  in  Washington, 
but  only  3.8  in  Berlin,  4.3  in  Vienna,  5.6  in  Hamburg  and  12.3  in 
London  (E.  O.  Jordan}.  Since  that  time,  however,  a  steady 
improvement  has  taken  place  in  the  United  States,  the  rate  falling 
to  23.5  per  100,000  in  1910  and  to  15.4  in  1914.  In  our  large  cities, 
the  rates  for  1914  ranged  from  6.3  for  New  York  to  22.6  for 
Baltimore,  while  the  average  rate  of  the  four  largest  cities  in 
Europe  (London,  Paris,  Berlin  and  Vienna)  was  only  4.75  for  the 
approximate  period  1910-1912. 

It  is  difficult  to  account  for  this  difference.  We  may  assume  that 
Americans  are  as  well  fed  and  lodged  as  Europeans,  that  although 
our  towns  leave  very  much  to  be  desired  in  the  way  of  sanitation, 
more  of  them  are  provided  with  adequate  water-supply  and  sewer- 
age than  in  England  or  Germany.  Typhoid  fever  is  not  a  disease 
of  the  poor  but  rather  of  the  well-to-do,  being  most  prevalent  among 
the  well-nourished  and  robust,  and  making  most  victims  in  early 
adult  life,  at  the  time  of  greatest  vitality.  It  is  not  improbable  that 
this  higher  susceptibility  in  the  United  States  is  due,  at  least  in 
part,  to  intemperance  in  eating,  especially  the  eating  of  meat,  in 
which  we  surpass  every  other  country.  This  hypothesis  is  strength- 
ened by  the  comparative  freedom  from  typhoid  fever  of  countries 
(outside  of  cities)  whose  people  are  too  poor  to  indulge,  more  than 
very  sparingly,  in  a  nitrogenous  diet.  Investigations  in  many  parts 
of  the  world  indicate  that  no  climatic  or  racial  influences  confer 
immunity  against  typhoid  fever,  but  that  it  is  much  less  prevalent 
among  primitive  or  semi-civilized  peoples  than  in  more  highly  civ- 
ilized and  better-fed  countries.  There  is  enough  evidence  on  this 
subject  (see  under  Food}  to  make  it  seem  unwise  to  allow  such 


38  MILITARY    HYGIENE. 

liberal  rations  as  to  practically  put  no  limitation  to  the  amount  of 
meat  that  soldiers  and  sailors  may  consume  in  camp  or  on  board 
ship,  as  the  tendency  has  been  of  late  years  by  those  who  still  dis- 
regard the  advantages  of  physiological  economy  in  nutrition. 

Prophylaxis. —  Troops  immunized  by  vaccination  do  not  require 
the  same  strict  watch  as  those  that  are  not  thus  protected,  but,  for 
obvious  reasons,  they  should  continue  to  receive  the  benefit  of  all 
the  well-known  measures  of  prevention. 

Every  case  of  typhoid  fever  must  be  regarded  as  highly  con- 
tagious and  treated  accordingly.  The  prompt  removal  of  the 
patient  from  his  company  and  regiment  to  post  or  field  hospital,  and 
the  disinfection  of  his  bedding,  clothing  and  effects,  will  be  the  first 
indications.  One  of  the  chief  duties  of  medical  officers  is  to  watch 
for  the  mild,  obscure,  atypical  cases,  sometimes  mere  gastric  malaise 
or  bilious  attack  in  men  who  do  not  feel  ill  enough  to  report  at  sick 
call,  or  dislike  to  take  the  risk  of  being  separated  from  their  com- 
rades. All  these  so-called  ambulant  cases  are  very  dangerous  and 
every  measure  should  be  taken  to  detect  them  in  their  inception. 
Any  man  with  febrile  temperature  not  easily  accounted  for,  espe- 
cially if  accompanied  with  gastro-intestinal  disturbance,  should  be 
isolated  until  the  nature  of  his  ailment  is  determined.  Blood  cul- 
tures will  generally  permit  an  earlier  and  surer  diagnosis  (from 
the  3d  to  the  8th  day  in  94  per  cent,  of  cases)  than  the  Widal  test. 
The  prompt  segregation  of  initial  cases  (as  in  all  infectious  diseases) 
is  the  first  and  one  of  the  most  important  measures  of  phophylaxis. 

As  it  is  in  camps  of  instruction  and  mobilization  that  outbreaks 
of  typhoid  fever  are  most  likely  to  occur  and  spread,  every  effort 
must  be  made  to  guard  them  against  infection.  All  troop  units 
under  orders  to  proceed  thereto  should  be  carefully  inspected  before 
leaving  their  first  rendezvous,  and  suspicious  cases  left  behind  until 
they  can  safely  rejoin  their  organizations.  This  inspection  gives 
the  special  sanitary  officers  appointed  for  the  purpose  the  oppor- 
tunity to  detect  men  who  have  not  yet  been  vaccinated  against 
typhoid  fever,  as  well  as  against  small-pox,  to  isolate  those  in  the 
incipient  stage  of  the  disease  or  who  have  been  dangerously  exposed 
to  it,  as  well  as  those  who,  although  entirely  recovered  from  an 
attack  of  it,  are  found  still  discharging  bacilli  in  their  excreta. 

Transmission  by  contact  is  the  more  insidious  and  dangerous  that 
it  is  connected  with  personal  cleanliness  and  habits,  therefore  diffi- 


DISEASES    OF   THE   SOLDIER.  39 

cult  of  detection  and  control.  The  hands  are  the  usual  means  of 
transmission  and  require  particular  care  (see  under  Personal 
Hygiene).  The  proper  and  careful  use  of  latrines,  particularly  of 
pit  privies,  in  camp,  so  as  not  to  infect  hands,  shoes  or  clothing, 
should  be  insisted  upon.  Urine  tubs  must  be  provided  for  the  night 
and  their  use  enforced.  The  fouling  of  camp  grounds  is  a  capital 
offense  against  hygiene,  to  be  visited  by  swift  and  severe  punish- 
ment. In  camp,  the  men  must  be  required,  if  not  supplied  with 
cots,  to  improvise  bedsteads  which  will  lift  their  blankets  and  cloth- 
ing above  the  dust  of  a  possibly  infected  soil.  (See  also  under 
Dissemination,  page  32,  and  Latrines,  page  648.) 

Antityphoid  Vaccination. —  Owing  to  the  impossibility  to  exclude 
all  typhoid  cases  from  camps,  the  lax  discipline  generally  existing 
among  volunteer  troops,  and  the  lack  of  sanitary  experience  of 
many  of  their  medical  officers,  it  is  plain  to  see  that  the  prevention 
of  serious  outbreaks,  in  case  of  mobilization  on  a  large  scale,  would 
always  be  a  very  difficult  problem  so  long  as  our  soldiers  remain 
particularly  susceptible  to  typhoid  infection.  How  to  render  them 
immune  .to  it  is  a  sanitary  question  of  capital  importance,  but  one 
which,  happily,  has  been  successfully  solved.  The  institution  of 
antityphoid  inoculation  is  another  epoch-making  step  in  the  science 
of  medical  prophylaxis,  one  that  saves  the  soldier  from  his  most 
dangerous  enemy  and  robs  war  of  one  of  its  terrors.  It  was  first 
elaborated  and  applied  in  England  by  Wright  and  Leishman,  and 
in  Germany  by  Pfeiffer  and  Kolle.  In  this  country  we  owe  its 
introduction  to  the  brilliant  work  and  persistent  efforts  of  Major 
F.  F.  Russell,  M.  C.,  U.  S.  Army,  under  the  auspices  of  Surgeon 
Generals  R.  M.  O'Reilly  and  G.  H.  Torney.  Typhoid  vaccination 
in  our  Army  was  begun  in  March,  1909,  on  officers  and  men 
(chiefly  of  the  Medical  Department)  who  volunteered  for  the  pur- 
pose. The  results  were  so  satisfactory  and  promising  that,  in 
March,  1911,  it  was  made  compulsory  by  the  War  Department  for 
all  troops  ordered  into  active  service  and,  in  June  of  the  same  year, 
for  all  recruits.  All  men  enlisting  or  drafted,  unless  they  are  over 
35  years  of  age  or  have  had  a  recent  attack  of  the  disease,  are  vac- 
cinated against  typhoid  fever  at  the  time  that  they  are  vaccinated 
against  small-pox. 

The  preparation  of  the  vaccin  is  comparatively  simple.  A  non- 
virulent  strain  of  the  typhoid  bacillus  is  grown  on  agar  in  Kolle 


4O  MILITARY    HYGIENE. 

flasks  for  18  hours ;  the  growth  is  washed  off  in  normal  salt  solu- 
tion and  standardized  so  as  to  contain  1,000,000,000  bacilli  to  the 
cubic  centimeter.  It  is  then  subjected  to  a  temperature  of  54  to 
55°  C.  in  a  water  bath  for  one  hour,  a  temperature  which  kills  all 
the  baccilli  without  injuring  the  toxin;  0.25  per  cent,  of  tricresol  is 
added  as  a  perservative,  and  the  finished  prophylactic  is  put  up  in 
hermetically-sealed  glass  ampuls.  Only  a  single  strain  of  the 
bacillus  has  been  used  in  this  country,  as  in  England,  with  the  idea 
that  the  method  of  preparation  should  be  as  simple  as  possible  con- 
sistent with  good  results,  so  that  an  adequate  supply  could  always 
be  promptly  procured  in  time  of  emergency.  This  rule,  however,  is 
liable  to  modifications,  and  whenever  paratyphoid  fever,  for  in- 
stance, is  recognized  or  suspected,  it  may  become  necessary  to  use 
a  mixed  vaccin  of  typhoid  and  paratyphoid. 

Vaccins  are  also  prepared  from  live  cultures ;  two  have  been 
shown  to  possess  practical  value,  namely,  Vincent's  polyvalent  auto- 
lysate,  and  the  attenuated  live  culture  of  Metchnikoff  and  Besredka. 
Vincent  grows  several  strains  (including  the  paratyphoid)  on  agar 
24  to  48  hours ;  the  growth  is  taken  up  in  salt  solution  and  .allowed 
to  macerate  for  several  days  at  a  temperature  of  37°  C.  This  bacil- 
lary  emulsion  is  centrifuged  and  the  supernatant  fluid  sterilized  by 
shaking  it  with  ether  which  is  then  allowed  to  evaporate.  This 
autolysate  has  been  used  in  France  and  among  French  troops 
with  marked  success.  In  the  preparation  of  Metchnikoff  and 
Besredka,  the  live  culture  is  "  sensitized "  by  contact  with  the 
serum  of  a  horse  highly  immunized,  so  that,  after  vaccination,  the 
bacilli  are  all  speedily  destroyed  by  phagocytes  and  antibodies.  It 
is  claimed  for  this  vaccin,  besides  absolute  safety,  an  extremely 
slight  reaction  and  more  lasting  immunity. 

A  complete  vaccination  consists  of  three  inoculations  at  lo-day 
intervals,  the  first  of  0.5  c.  c.  and  the  others  of  i  c.  c.  each.  The 
injection  is  generally  given  in  the  arm  at  the  insertion  of  the  deltoid 
muscle.  It  should  be  subcutaneous,  not  muscular,  and  care  taken 
that  the  needle  does  not  enter  a  vein,  for  fear  of  a  possible  excessive 
reaction.  With  proper  system,  two  medical  officers  and  four  as- 
sistants can  easily  vaccinate  several  hundred  men  a  day  and  strictly 
observe  all  antiseptic  precautions.  Nelson  and  Hall  paint  the  skin 
with  iodine,  without  any  previous  cleaning,  and  seal  the  puncture 
with  collodion ;  with  this  method  they  claim  to  be  able  to  vaccinate 


DISEASES    OF   THE    SOLDIER.  4! 

300  men  per  hour.  Following  the  vaccination,  within  6  or  8  hours, 
there  is  a  local  reaction  consisting  of  a  red  and  tender  area,  about 
the  size  of  the  palm  of  the  hand,  at  the  point  of  puncture.  There 
may  also  be  a  general  reaction,  with  pyrexia,  headache,  malaise, 
occasional  chills  and,  quite  rarely,  nausea,  vomiting  or  diarrhea. 
These  symptoms  usually  subside  within  24  hours,  or  48  hours  in 
the  severest  reactions.  In  the  last  series  of  vaccinations  published 
(27,720  men  inoculated  from  January  i  to  June  30,  1911),  the 
systemic  reaction  was  absent  or  mild  in  99  per  cent,  of  the  cases, 
and  severe  in  only  3  per  thousand  of  those  receiving  the  first  dose. 
In  no  case  has  there  been  any  untoward  result,  not  even  an  abscess 
at  the  site  of  inoculation. 

It  was  believed,  until  recently,  that  the  first  dose  of  vaccin,  by 
temporarily  decreasing  the  antibodies  in  the  blood,  produced  a 
"  negative  phase  "  during  which  there  was  an  increased  suscepti- 
bility to  typhoid  infection.  Experience  has  shown  that,  practically, 
there  is  no  such  phase,  but  that,  on  the  contrary,  increased  resistance 
begins  almost  immediately.  There  might  be  danger,  however,  in 
vaccinating  subjects  during  the  incubation  or  incipient  stage  of  the 
disease :  therefore  in  the  case  of  men  showing  symptoms  of  fever, 
or  illness,  the  operation  should  be  postponed. 

Laboratory  researches  demonstrate  a  marked  increase  of  anti- 
bodies (agglutinin,  opsonin  and  bacteriolysin)  within  8  or  10  days 
after  vaccination,  an  increase  said  to  be  greater  than  that  which 
follows  an  attack  of  typhoid  fever.  This  and  other  reasons  justify 
the  belief  that  the  immunity  conferred  by  vaccination  will  last  at 
least  two  or  three  years,  but  that  the  present  regulation  requiring 
revaccination  upon  reenlistment  is  wise  and  should  be  adhered  to. 

The  total  number  of  men  vaccinated  since  March,  1909,  to  July, 
1911,  in  the  U.  S.  Army,  was  45,680,  but  only  38,902  received  three 
doses.  Of  this  total  number  n  have  had  typhoid  fever  and  none 
died,  a  rate  of  admission  of  0.24  per  thousand.  Of  these  n  cases, 
at  least  2  had  only  received  two  doses,  while  in  4  the  diagnosis  was 
doubtful.  The  almost  perfect  efficacy  of  typhoid  vaccination  was 
particularly  demonstrated  by  the  troops  sent  to  Texas  in  March 
and  April,  1911.  By  order  of  the  Secretary  of  War  those  not 
already  immunized  were  all  vaccinated  upon  their  arrival  in  camp. 
The  mean  strength  of  the  command  at  San  Antonio  was  12,800, 
and  of  the  command  in  Galveston  between  3.000  and  4,000  men,  a 


42  MILITARY    HYGIENE. 

total  of  at  least  16,000  men.  So  far  as  known  not  a  single  case 
occurred  in  the  Galveston  troops,  although  192  cases  were  reported 
in  the  city  during  the  same  period.  Only  two  cases,  without  death, 
occurred  in  the  San  Antonio  command.  It  should  be  noted  that 
these  troops  were  not  confined  to  the  limits  of  their  cantonments, 
but  that  when  not  on  scouting  duty  (which  was  unusually  arduous) 
they  were  permitted  free  intercourse  with  the  populations  of 
neighboring  towns. 

For  the  year  1915,  out  of  a  mean  strength  of  104,000  men,  8  cases 
of  typhoid  fever  were  reported,  of  which  7  had  been  vaccinated  at 
previous  periods  ranging  from  8  months  to  4  years.  No  deaths 
occurred. 

Very  striking  results  have  likewise  oeen  obtained  in  the  English, 
German  and  Japanese  Armies.  Of  the  English  troops  serving  in 
India,  in  1911,  the  rates  of  admissions  and  deaths  for  the  non- 
inoculated  were  5.9  and  1.15,  and  for  the  inoculated,  1.7  and  0.17 
respectively. 

It  should  be  added  that  typhoid  vaccin  does  not  immunize  against 
paratyphoid  fever,  and  that  it  is  highly  probable  that  of  the  cases 
occurring  among  the  vaccinated  in  our  Army,  a  few  have  been  of 
that  disease.  The  observations  of  English  medical  officers  in  India 
tend  to  show  that  paratyphoid  fever  is  more  common  than  generally 
believed,  and  that  it  may  be  deemed  advantageous,  in  certain  circum- 
stances, to  use  a  polyvalent  (or  rather  a  bivalent)  vaccin  to  protect 
against  both  diseases. 

PARATYPHOID  FEVER. 

This  is  a  disease  resembling  mild  atypical  forms  of  typhoid  fever, 
with  case  mortality  seldom  exceeding  3  per  cent.  It  seldom  occurs 
in  epidemic  form,  but  often  coexists  with  typhoid  fever  in  endemic 
foci.  In  India,  15  per  cent,  of  cases  reported  clinically  as  typhoid 
fever  were  found  to  be  paratyphoid  infections  (mostly  type  A). 
Thousands  of  cases  have  been  reported  from  the  belligerent  armies 
in  western  Europe  (mostly  type  B),  and  believed  to  be  one  of  the 
principal  causes  of  "  trench  diarrhea." 

Paratyphoid  fever  is  caused  by  bacilli  intermediate  between  the 
typhoid  and  colon  organisms.  Of  these  bacilli  two  types  are  recog- 
nized, A  and  B.  Clinically  they  are  hardly  distinguishable,  and 
extremely  variable  in  their  manifestations. 


DISEASES    OF    THE    SOLDIER.  43 

The  diarrheal  form  of  paratyphoid,  often  seen  in  the  French  and 
British  armies,  closely  resembles  food  poisoning  clinically,  the 
patient,  within  a  few  hours  after  the  ingestion  of  meat,  being  seized 
with  headache,  fever,  vomiting  and  severe  diarrhea. 

The  Widal  reaction  being  of  no  value  in  immunized  persons,  and 
the  differential  diagnosis  by  agglutination  always  difficult,  the  best 
method  of  distinguishing  typhoid  from  paratyphoid  and  other  con- 
tinued fevers  is  by  blood  cultures,  between  the  2d  and  5th  days  of 
the  disease. 

The  modes  of  infection  seem  to  be  exactly  those  of  typhoid  fever. 
Prophylaxis  requires  vaccination  with  a  mixed  vaccin  of  paratyphoid 
A  and  B,  or  as  practised  in  the  French  and  British  armies,  of 
typhoid  and  the  two  paratyphoid  types  (the  so-called  T.  A.  B.  mix- 
ture). Special  attention  should  be  given  to  the  detection  and  isola- 
tion of  carriers. 

A  few  cases  are  generally  reported  every  year  from  our  troops 
in  the  United  States  and  colonies.  Thus,  in  1915,  9  cases  occurred 
in  the  entire  Army,  3  in  the  Philippines,  I  in  the  Hawaiian  Islands 
and  5  in  the  United  States.  Of  them,  6  were  caused  by  Bacillus  A. 
In  August,  1916,  an  outbreak  of  paratyphoid  occurred  among  our 
troops  on  the  Rio  Grande,  in  Texas,  in  all  120  cases.  This  was 
promptly  and  satisfactorily  checked  by  vaccination  with  mixed  vac- 
cin of  both  types  A  and  B,  a  vigorous  search  for  possible  "  car- 
riers "  and  a  change  of  camp  sites. 

It  is  to  be  noted  that  as  the  number  of  paratyphoid  cases  identi- 
fied in  our  Army  increases,  there  is  a  corresponding  decrease  of 
cases  of  simple  continued  fever,  indicating  a  greater  skill  and  accu- 
racy in  diagnosis. 


CHAPTER  III. 
INFECTIOUS  DISEASES  (CONTINUED). 

DIARRHEA  AND  DYSENTERY. 

Diarrhea  is  quite  prevalent  among  troops  serving  at  home  and  in 
our  insular  possessions,  being  always  one  of  the  five  diseases  having 
the  highest  rates  of  admissions.  These  rates  (mean  annual),  for 
the  period  1908-1910,  were  34.90  per  thousand  in  the  United  States 
and  73.29  in  the  Philippines,  with  mortality  of  0.02  and  0.05  re- 
spectively. They  show  that  diarrhea,  in  normal  times,  although  one 
of  the  principal  causes  of  non-effectiveness,  is,  so  far  as  death  is 
concerned,  a  negligible  factor.  Dysentery,  a  disease  of  little  im- 
portance at  home,  is  much  more  prevalent  and  serious  in  the  tropics. 
Thus  the  rates  (mean  annual)  for  the  United  States  and  the  Philip- 
pines, during  the  same  period  1908-1910,  were,  for  admissions, 
2.12  and  29.56  respectively,  and,  for  deaths,  o.oi  and  0.57.  Dysen- 
tery is  nearly  always  among  the  five  diseases  causing  the  highest 
mortality  in  the  Philippines. 

For  1915,  a  marked  decrease  in  the  incidence  of  dysentery  is 
noted  in  the  Philippines,  with  an  admission  rate  of  5.32  per  1,000, 
as  compared  with  12.97  m  I9I4!  the  death  rates  for  those  two 
years  being  0.17  and  0.09  respectively. 

In  war,  dysentery  and  diarrhea  assume  an  importance  and  pro- 
duce a  mortality  which  may  equal  or  even  exceed  that  of  typhoid 
fever.  In  the  Medical  History  of  the  Rebellion  they  are  thus 
described : 

"  These  disorders  occurred  with  more  frequency  and  produced 
more  sickness  and  mortality  than  any  other  form  of  disease.  They 
made  their  appearance  at  the  very  beginning  of  the  war,  not  infre- 
quently prevailing  in  new  regiments  before  their  organization  was 
complete,  and  although,  as  a  rule,  comparatively  mild  at  first,  were 
not  long  in  acquiring  a  formidable  character.  Soon  no  army  could 
move  without  leaving  behind  it  a  host  of  the  victims.  They 
crowded  the  ambulance  trains,  the  railroad  cars,  the  steamboats. 
In  the  general  hospitals  they  were  often  more  numerous  than  the 
sick  from  all  other  diseases,  and  rivalled  the  wounded  in  multitude." 

They  caused  57,265  deaths  in  the  federal  armies,  corresponding  to 

44 


MILITARY  HYGIENE  — HAVARD 


PLATE  II. 


A 


1.  Bacillus  of  tetanus  in  pure  culture. 

2.  Bacillus  of  dysentery  (Shiga)  in  pure  culture. 

3.  Bacillus  of  anthrax  in  pure  culture,  spores  stained. 

4.  Gonococcus  in  pus  cell. 

5.  Meningococcus  in  pure  culture. 

6.  Baccillus  of  plague  in  smear  from  spleen. 


INFECTIOUS   DISEASES    (CONTINUED).  45 

a  yearly  mortality  of  17  per  1,000,  or  one  death  out  of  every  3.5 
deaths  from  all  sickness.  The  case  mortality  was  i  death  to  395 
cases  of  acute  diarrhea,  57  of  acute  dysentery,  6  of  chronic  diarrhea 
and  8  of  chronic  dysentery.  They,  besides,  caused  over  18,000  dis- 
charges. It  is  probable  that  many  deaths  from  typhoid  fever,  wrong- 
fully diagnosed  dysentery,  should  be  deducted  from  the  above  total. 
Even  with  this  correction  the  victims  from  dysentery  and  diarrhea 
greatly  outnumbered  those  from  typhoid  fever.  The  great  pre- 
dominance of  these  diseases  during  the  Civil  War  is  surprising,  and 
has  not  been  equalled  in  any  other  modern  war,  except  perhaps  the 
Sino-Japanese  War  of  1894-5.  During  the  year  of  the  Spanish- 
American  War,  1898,  their  death  rate  was  only  2.14.  In  the  Boer 
War,  the  relation  of  the  mortality  from  typhoid  fever  to  that  of 
dysentery  was  as  6  to  I ;  in  the  Franco-German  War,  this  relation 
was  as  4  to  i ;  in  the  Spanish- American  War  as  8  to  I.  On  the 
other  hand,  in  the  Sino-Japanese  War  dysentery  caused  more  deaths 
than  all  other  diseases  combined. 

Simple  diarrhea  may  result  from  the  ingestion  of  excessive,  indi- 
gestible or  unwholesome  food,  or  impure  water,  or  from  exposure 
to  inclement  weather,  damp  soil  or  foul  air.  That  it  is  mostly 
caused  by  fermentative  or  putrefactive  organisms  is  proved  by  the 
striking  effect  of  heat  upon  its  rate  which,  in  the  United  States,  is 
lowest  in  January  and  February  and  highest  in  August.  In  camps 
it  is  often  contagious  and  may  become  epidemic,  indicating  the  pres- 
ence in  the  stools  of  pathogenic  organisms,  perhaps  some  of  the 
ordinary  parasitic  and  generally  harmless  bacilli  of  the  intestinal 
canal  which  assume  a  certain  degree  of  virulence  under  special 
conditions.  The  younger  the  soldier  the  more  liable  he  is  to  this 
disease. 

The  etiology  of  dysentery  has  not  yet  been  satisfactorily  cleared 
up ;  the  true  causes  of  its  various  forms  and  the  symptoms  pertain- 
ing to  each  will  require  further  investigation  before  we  possess  a 
complete  knowledge  of  the  subject.  Our  present  information  leads 
us  to  the  conclusion,  as  stated  by  Manson,  that  three  factors  are 
concerned  in  the  production  of  dysentery :  ( i )  weakening  or  irri- 
tating influences  such  as  bad  food,  purgatives,  indigestion,  diarrhea, 
intemperance,  etc.,  which  prepare  the  ground  for  (2)  the  specific 
germs  which,  subsequently,  have  their  action  supplemented  by  (3) 
the  ordinary  bacteria  of  suppuration.  The  irritating  influences  re- 


46  MILITARY    HYGIENE. 

ferred  to  may  produce  a  catarrhal  condition  which  later  develops 
into  severe  dysenteric  symptoms  without  the  operation  of  any  known 
specific  germs ;  this  is  the  so-called  catarrhal  dysentery. 

Two  chief  types  of  dysentery  are  caused  by  parasites,  bacillary 
dysentery  and  cntamebic  dysentery.  They  are  entirely  distinct,  but 
occasionally  one  may  complicate  the  other.  Bacillary  dysentery  is 
found  in  all  parts  of  the  world  and  under  many  different  climatic 
conditions.  Its  causative  organisms  are  several  forms  of  closely 
related  bacilli,  divided  by  Hiss  into  four  types:  the  Shiga,  Hiss- 
Russell,  Flexner-Strong  and  the  Harris.  They  are  differentiated 
by  fermentation  and  agglutination  tests,  but  all  possess  an  identical 
morphology,  the  same  staining  characteristics  and  lack  of  motility, 
with  the  inability  to  liquefy  gelatin  and  produce  gas.  The  best 
known  and  most  common  is  the  Bacillus  dysenteries  of  Shiga,  a 
short  rod  with  rounded  ends  and  very  similar  to  the  typhoid  bacillus. 
They  are  all  easily  destroyed  by  heat  (60°  C.)  and  the  ordinary 
disinfectants,  but  show  considerable  resistance  to  cold,  surviving 
freezing  for  several  weeks. 

Bacillary  dysentery,  whether  caused  by  one  or  the  other  of  these 
organisms,  docs  not  differ  in  its  clinical  course,  pathology,  gravity 
and  treatment,  so  that  the  identification  of  the  bacillus  type  is  not 
of  practical  importance.  It  is  characterized  by  acute  onset,  often 
with  chill,  the  presence  of  the  specific  bacillus  in  the  stools,  non- 
liability to  liver  abscess  and  non-tendency  to  relapse.  This  is  the 
epidemic  dysentery  of  armies,  especially  in  temperate  climates,  and 
susceptible  of  becoming  highly  infectious,  although  probably  never 
to  the  same  extent  as  typhoid  fever.  It  is  the  form  that  prevailed 
in  the  Civil  War,  in  European  wars,  in  the  Boer  War  and  in  the 
Russo-Japanese  War.  It  is  also  possible  that  the  bacilli  of  dysen- 
tery may,  under  less  virulent  forms,  be  concerned  in  the  etiology  of 
infectious  and  epidemic  diarrheas,  such  as  sometimes  prevail  in 
armies  and  other  human  agglomerations.  The  contention  that  they 
are  only  pathogenic  forms  of  the  common  colon  bacillus  which, 
under  special  influences,  acquires  virulent  properties,  has  not  been 
proved,  although  it  is  generally  admitted  that  the  colon  bacillus  and 
other  normally  harmless  intestinal  bacteria  may  become  more  or  less 
pathogenic  and  produce  severe  diarrheal  and  digestive  disturbances. 

The  incidence  of  bacillus  carriers  in  dysentery  is  as  great  as  in 
typhoid  fever,  if  not  greater.  Therefore  the  danger  of  contact  and 


MILITARY  HYGIENE  — HAVARD 


PLATE  III. 


I,  2,  3.    Entamccba  coli  in  fresh  dysenteric  stool;  the  same  parasite  photo- 
graphed at  3O-second  intervals. 

4.  Entamcrba    histolytica    in    fresh    dysenteric    stool ;    parasite    filled    with 

blood. 

5.  Entamacba  tetragena;  living  parasites  containing  red  blood  cells. 


INFECTIOUS    DISEASES    (CONTINUED).  47 

of  infecting  latrines  is  as  threatening;  convalescents,  in  the  military 
service,  should  be  returned  to  duty  only  under  the  same  restrictions 
that  are  applied  to  typhoid  convalescents. 

Entamebic  dysentery  is  characteized  by  the  insidious  onset,  marked 
tendency  to  chronicity  and  frequent  relapses,  the  presence  of  amoebae 
in  the  stools  (mostly  in  the  bloody  mucus)  and  great  liability  to 
liver  abscess.  It  is  mostly  a  disease  of  warm  climates  and  is  less 
contagious  than  the  former,  prevailing  mostly  in  a  sporadic  or 
endemic  form. 

Amoebae  are  microscopic  animalcules  in  the  shape  of  rounded 
masses  of  'protoplasm,  with  nucleus,  nucleolus  and  vacuoles,  and 
often  finger-like  projections.  They  are  common  in  all  parts  of  the 
world  and  abundant  in  the  tropics.  As  shown  by  Musgrave  and 
Clegg  they  are  almost  ubiquitous  in  the  Philippine  Islands,  'being 
found  in  most  surface  waters  under  various  forms.  From  the  inves- 
tigations of  Walker,  Craig,  Whitmore  and  others,  it  appears  that 
the  amoeboid  organisms  found  in  the  intestinal  tract  of  man  belong 
to  a  distinct  genus,  Entamceba,  and  that  they  are  strict  parasites, 
that  is  to  say,  incapable  of  multiplication  outside  the  body  of  their 
host.  Three  species,  distinguishable  under  the  microscope,  have  been 
described:  E.  coli,  with  distinct  nucleus  near  the  center  of  the 
organism,  thick  nuclear  membrane  and  abundant  chromatin ;  its 
movements  are  sluggish  and  does  not  ingest  red  blood  corpuscles ; 
it  develops  cysts  containing  8  nuclei.  E.  histolytica,  with  indistinct 
or  hardly  visible  nucleus,  eccentric  in  position,  without  limiting 
membrane  and  very  poor  in  chromatin ;  its  movements  are  active 
and  it  frequently  ingests  red  blood  corpuscles;  it  develops  cysts 
containing  4  nuclei.  E.  tetragena,  differing  from  the  preceding  in 
having  a  distinct  nucleus  with  thick  membrane,  and  being  rich  in 
chromatin.  The  latter  species  has  been  shown  by  Walker  and  Craig 
to  be  only  the  cystic  stage  of  the  life-cycle  of  histolytica  into  which 
it  merges  through  various  intermediate  forms.  E.  coli  is  now  con- 
sidered a  harmless  parasite,  while  E.  histolytica  has  been  proved  to 
be  pathogenic  and  the  specific  cause  of  entamebic  dysentery.  Craig 
has  shown  that  the  latter,  whether  fed  in  milk  or  injected  through 
the  rectum,  produces  in  kittens  the  typical  lesions  of  entamebic  dysen- 
tery as  observed  in  man,  while  the  E.  coli  when  thus  used  is  abso- 
lutely harmless.  Ashburn  and  Craig  (Military  Surgeon,  September, 
1907)  found  that,  of  100  healthy  American  soldiers  examined  in 


48  MILITARY    HYGIENE. 

Manila,  72  showed  the  presence  of  E.  coll  in  their  stools;  that  in 
many  of  them  the  organisms  disappeared,  but  that,  in  the  larger 
number  of  cases,  they  were  still  found  after  the  lapse  of  9  months, 
during  which  the  men  remained  perfectly  free  from  dysentery  and 
diarrhea.  Other  observers  have  reached  the  same  conclusion,  and 
it  may  be  considered  established  that  a  large  proportion,  sometimes 
a  majority,  of  healthy  people  in  temperate  and  tiopical  countries 
carry  amcebae  in  their  intestines. 

Entamebic  dysentery  is  mostly  found  in  tropical  and  subtropical 
countries,  but  is  not  rare  even  in  the  northern  United  States  in  a 
less  virulent  form.  It  is  the  more  common  type  in  all'our  Island 
possessions. 

An  outbreak  of  it,  with  total  of  156  cases,  among  the  troops  serv- 
ing in  the  El  Paso  district  and  the  Punitive  Expedition  in  Mexico, 
between  July  and  November,  1916,  was  critically  investigated  by 
Craig,*  who  reached  the  inevitable  conclusion  that  the  disease  had 
been  carried  and  disseminated  by  flies  from  infected  latrines. 

It  is  now  generally  accepted  that  the  cysts  of  Entamccba  his- 
tolytica,  as  passed  by  carriers,  are  the  infective  agents  in  the  vast 
majority  of  instances,  infection  through  the  motile  forms  rarely 
occurring  in  man  owing  to  the  destructive  action  of  the  gastric  juice 
upon  them.  Therefore  the  greatest  source  of  danger  is  not  the 
patient  sick  with  acute  symptoms,  but  the  "  carrier "  of  cysts, 
namely,  the  healthy  individual  who  discharges  cysts  although  never 
having  had  symptoms  of  dysentery  (contact  carriers),  and  the 
patient  who  has  recovered  from  the  acute  attack  but  develops  cysts 
during  convalescence  (convalescent  carrier).  These  "cysts  retain 
their  vitality  a  number  of  days  in  water  or  when  kept  moist,  but 
promptly  dry  and  shrivel  up  when  exposed  to  sunlight.  They  can 
be  demonstrated  in  the  intestine  and  excreta  of  flies  as  long  as 
eighteen  hours  after  these  insects  have  been  fed  upon  material  con- 
taining them. 

Another  form  of  dysentery,  rather  rare,  distinct  from  but  simu- 
lating the  entamebic  type,  is  that  caused  'by  the  Balantidium  coli,  an 
infusorial  parasite  of  the  intestine,  specially  studied  by  Strong  and 
Musgrave.  It  is  a  widely  distributed  disease,  occurring  in  Europe, 
Africa,  China,  North  America  and  the  Philippine  Islands.  Its  mode 

*The  Military  Surgeon,  March  and  April,  1917.  By  Major  C.  F.  Craig, 
U.  S.  Army. 


INFECTIOUS   DISEASES    (CONTINUED).  49 

of  transmission  is  still  undetermined.  Beginning  with  mild  inter- 
mittent diarrhea,  it  gradually  becomes  dysenteric  in  character. 
The  symptoms  may  suddenly  disappear  for  a  few  days,  but  always 
return  with  increased  severity.  The  prognosis  is  bad. 

Abscess  of  the  Liver. —  One  of  the  most  serious  sequels,  or  con- 
current diseases,  of  the  entamebic  dysentery  of  the  tropics  is  abscess 
of  the  liver.  There  is  an  intimate  relationship  between  the  two 
diseases,  dysentery  having  been  found  to  be  a  factor  in  nearly  every 
case  of  tropical  liver  abscess.  This  disease  is  rare  among  the 
natives,  but  common  among  Europeans  and  Americans,  especially 
the  men,  its  exciting  cause  being  generally  intemperate  habits  and 
exposure.  Women  and  children  seldom  suffer  from  it. 

Prophylaxis. —  Dysentery,  like  typhoid  fever  and  cholera,  results 
from  the  ingestion  into  the  stomach  and  intestinal  canal,  with  food 
or  drink,  of  fecal  matter  containing  the  infective  organism.  Like 
those  diseases,  it  is  often  water-borne,  many  of  the  epidemics  of 
dysentery  being  fairly  attributable  to  infected  water-supply.  There 
is  no  doubt,  however,  that,  in  military  camps,  most  cases  are  propa- 
gated by  flies  and  direct  or  indirect  contact  with  patient  or  carrier, 
so  that,  practically,  the  same  preventive  measures  are  required  as 
in  typhoid  fever.  It  is  quite  probable  that  so  long  as  the  mucous 
membrane  of  the  intestinal  canal  is  sound  and  normal,  it  can  protect 
itself  against  the  pathogenic  organisms  of  dysentery,  but  any  cause 
which  produces  an  irritation  and  congestion  of  the  bowels,  with 
consequent  diarrhea,  such  as  exposure  to  cold  and  wet  in  combina- 
tion with  unwholesome  diet,  may  break  this  barrier  and  bring  about 
an  infection  of  the  system.  Hence  the  importance,  in  the  presence 
of  an  outbreak  of  dysentery  or  of  a  suspected  water-supply,  to  avoid 
excesses  in  eating  and  drinking,  unnecessary  exposure  to  inclement 
weather  and  sudden  changes  of  temperature.  In  the  tropics  there 
is  usually  a  great  fall  of  temperature  during  the  night,  and  persons 
going  to  bed  without  enough  covering  are  liable  to  wake  up  chilled. 
It  is  to  be  noted  that  if  the  body  is  uncovered  while  perspiration  is 
free  and  evaporation  active,  the  abdomen  will  be  first  to  be  chilled; 
in  this  way  the  incipient  diarrhea  of  dysentery  may  be  started. 
This  sensitiveness  of  the  abdomen  is  not  rare  in  the  tropics,  and 
men  who  suffer  from  it  should  wear  a  flannel  abdominal  band  at 
night.  Such  protection,  however,  is  seldom  necessary  or  advisable 
during  the  day. 


5<D  MILITARY    HYGIENE. 

When  diarrheal  diseases  become  prevalent  in  camp,  special  care 
must  be  observed  in  the  use  of  vegetables  and  fruits.  No  uncooked 
vegetable  should  be  eaten,  unless  carefully  washed  with  sterilized 
water  or  scalded  with  boiling  water.  Fruits  should  be  washed  in 
sterilized  water  and  then  skinned  or  peeled,  and  only  the  interior 
pulp  consumed. 

Whenever  a  case  of  entamebic  dysentery  is  discovered  in  any 
organization,  the  following  measures  should  be  strictly  carried  out 
to  prevent  the  spread  of  the  infection.  A  microscopic  examination 
of  the  stools  of  all  soldiers  whose  duties  are  connected  with  the 
preparation  or  serving  of  food  or  drink,  should  be  made  for  cysts 
of  E.  histolytica,  and  all  carriers  removed  at  once  to  the  hospital  for 
treatment.  If  they  prove  resistant  to  treatment  they  should  be  dis- 
charged from  the  service.  The  excreta  of  all  carriers  must  be  dis- 
infected immediately  after  passage  whenever  practicable.  The  pre- 
vention of  the  breeding  of  flies  and  their  destruction,  as  well  as  the 
screening  of  kitchen  and  mess  tents,  are  measures  of  the  greatest 
importance,  for  these  insects  are  undoubtedly  the  greatest  factor  in 
the  spread  of  entamebic  dysentery  in  temporary  or  semi-permanent 
camps  (Craig}. 

SPRITE  (PSILOSIS).* 

A  very  dangerous  form  of  chronic  catarrhal  inflammation  of  the 
mucous  membrane  of  parts  of  the  alimentary  canal,  and  character- 
ized "  by  an  inflamed,  bare  and  eroded  condition  of  the  mucous 
membrane  of  the  tongue  and  mouth ;  by  flatulent  dyspepsia ;  by 
pale,  phenomenally  copious  and  generally  loose,  frothy,  fermenting 
stools ;  by  wasting  and  anemia ;  and  by  a  tendency  to  relapse  " 
•  {Manson}.  A  tropical  disease  common  in  parts  of  the  Philippine 
Islands,  China,  India,  Africa  and  the  West  Indies.  Nothing  definite 
is  known  as  to  its  cause.  It  may  be  infectious,  but  it  is  not  directly 
contagious.  Prolonged  residence  in  an  endemic  area  seems  neces- 
sary to  contract  it.  All  depressing  influences  predispose  to  it ; 
exhausting  diseases,  particularly  those  involving  the  alimentary 
canal,  such  as  dysentery,  are  apt  to  terminate  in  it.  Sprue  is  rare 
among  the  natives.  To  what  extent  its  incidence  may  be  ascribed 
to  any  excess  in  eating  or  drinking,  or  unhygienic  conditions,  has 
not  been  determined. 

*  Not  to  be  confounded  with  the  ordinary  thrush  or  stomatitis  of  tem- 
perate climates,  also  frequently  called  sprue. 


INFECTIOUS   DISEASES    (CONTINUED).  51 

CHOLERA. 

Cholera,  endemic  in  India  and  other  parts  of  Asia,  has  from  time 
to  time  spread  over  Europe  and  America  in  an  acute  epidemic  form 
with  case  mortality  of  nearly  50  per  cent.  Its  last  visitation  to  the 
United  States  was  in  1870-73,  when  it  entered  by  way  of  Jamaica 
and  New  Orleans.  In  this  country  cholera  has  ceased  to  be  a  seri- 
ous menace  for  it  is  believed  that,  even  should  some  individual  cases 
elude  the  quarantine,  the  infection  could  soon  be  controlled  and 
prevented  from  assuming  epidemic  proportions.  In  the  tropics, 
however,  cholera  still  persists  in  many  endemic  zones  and  breaks 
out  now  and  then,  showing  the  necessity  for  constant  vigilance.  In 
the  Philippine  Islands  an  epidemic  began  in  March,  1902,  raged 
among  the  natives  and  was  not  suppressed  until  April,  1904.  The 
last  case  among  soldiers  during  that  period  was  in  October,  1903, 
and  no  other  case  occurred  until  1905,  when  there  were  9  admis- 
sions with  2  deaths ;  during  1906  there  were  7  admissions  with  3 
deaths.  Cholera  became  again  particularly  prevalent  throughout 
the  Islands  in  1909  and  1910.  In  the  latter  year  2  cases  occurred 
among  American  soldiers,  both  of  whom  recovered.  In  1911  the 
epidemic  had  greatly  subsided.  "  When  it  is  remembered  that  chol- 
era occurs  in  epidemic  form  in  so  many  native  towns  adjacent  to 
our  military  posts,  it  must  be  recognized  that  the  almost  entire 
immunity  of  the  troops  is  due  to  the  excellent  sanitary  measures 
adopted  for  its  prevention." 

It  has  been  reported  from  various  parts  of  southeastern  Europe 
and  of  Asia,  in  1915  and  1916,  but  was  kept  out  of  the  belligerent 
armies  or  promptly  checked  when  introduced. 

Cholera  is  carried  by  man  from  country  to  country,  following  the 
routes  of  commercial  intercourse,  and  is  often  spread  by  polluted 
water-supply.  But,  like  typhoid  fever,  it  is  also  propagated  by  flies, 
infected  food,  clothing  and  utensils,  and  by  personal  contact.  In 
the  Philippines,  contaminated  water  seems  to  have  but  little  to  do 
with  the  outbreaks  of  this  disease.  On  being  ingested,  the  germ 
multiplies  in  the  alimentary  canal  awd  abounds  in  the  characteristic 
rice-water  discharges  of  patients.  It  is  not  found  in  the  urine. 

The  causative  organism  of  cholera  is  an  actively  motile  spirillum, 
with  single  polar  flagellum.  It  multiplies  with  great  rapidity,  break- 
ing into  comma-shaped  fragments,  small  curved  rods,  short  and 
thick,  to  which  the  name  of  "  comma  bacillus  "  has  been  given. 


52  MILITARY    HYGIENE. 

This  spirillum  is  not  easily  differentiated  from  other  similar  organ- 
isms ;  cultural  characteristics,  like  morphology,  often  yield  uncertain 
results ;  a  positive  diagnosis,  in  many  cases,  can  only  be  established 
upon  the  agglutination  reaction  (i  to  1,000)  with  culture  from  fecal 
material,  and  Pfeiffer's  phenomenon.  Otherwise  it  matters  not 
whether  the  organism  is  straight,  curved  or  spiral.  Its  growth  is 
arrested  below  59°  or  above  107°  F.  Freezing  does  not  immedi- 
ately destroy  it,  but  a  temperature  of  122°  kills  it.  In  the  soil,  or 
when  dried,  it  soon  dies,  but  may  retain  its  vitality  for  a  number  ot 
days  if  kept  moist,  as,  for  instance,  in  damp  soiled  linen  and  food- 
stuffs. 

It  is  an  interesting  fact  that  it  can  be  injected  beneath  the  skin 
with  impunity,  while  it  may  cause  death  if  taken  into  the  bowel. 

Prophylaxis. —  Cholera  is  one  of  the  quarantinable  diseases  in  this 
country,  but  its  incubative  period  is  so  variable,  ranging  from  a  few 
hours  to  ten  days,  that  efficient  quarantine  is  difficult.  The  official 
period  of  detention  is  five  days. 

As  in  typhoid  fever,  the  germs  may  be  conveyed  by  carriers,  that 
is,  individuals  harboring  it  in  their  intestines  without  exhibiting  any 
signs  of  the  disease.  During  an  epidemic  these  carriers  are  numer- 
ous, sometimes  amounting  to  6  or  8  per  cent,  of  the  healthy  indi- 
viduals living  in  infected  neighborhoods.  Generally  the  spirillum 
disappears  from  the  stools  of  convalescents  in  4  or  5  days,  and  is 
seldom  seen  after  20  days,  but,  through  the  infection  of  the  biliary 
apparatus,  may  persist  several  months.  Inasmuch  as  the  ordinary 
quarantine  examination  would  fail  to  detect  carriers,  the  Public 
Health  Service  imposes  a  bacterial  examination  of  the  stools  of  all 
steerage  passengers  coming  from  infected  ports  and  places. 

The  quality  of  the  water-supply  should  first  receive  attention. 
No  water  that  is  not  clearly  above  suspicion  should  be  used  for 
drinking,  cooking  or  bathing.  A  sound  mucous  membrane  is  much 
more  likely  to  resist  the  invasion  of  the  comma  bacillus  than  if 
abraded;  therefore  any  cause  of  digestive  disturbance  and  intestinal 
catarrh  must  be  carefully  avoided.  The  measures  of  prevention 
against  flies  already  mentioned  under  typhoid  fever  and  dysentery 
must  be  likewise  strictly  applied.  Raw  vegetables  and  fruits,  espe- 
cially from  native  markets,  are  dangerous.  All  patients  must  be 
kept  in  strict  isolation,  and  their  bodies,  discharges,  clothing  and 
bedding  thoroughly  disinfected. 


INFECTIOUS   DISEASES    (CONTINUED).  53 

The  following  practical  rules  enforced  among  American  troops  in 
the  Philippine  Islands  during  an  epidemic  of  cholera  are  well  worth 
.  remembering : 

Do  not  visit  native  houses  and  shops  or  partake  of  native  food  or 
drink  of  any  description. 

Do  not  drink,  or  brush  teeth  with,  any  other  than  distilled  or 
sterilized  water. 

Do  not  eat  cold  or  uncooked  food,  except  bread  and  crackers ;  all 
food  must  be  freshly  cooked  and  served  hot. 

Wash  all  crockery,  glass,  knives,  forks,  spoons,  etc.,  immediately 
after  meals  with  water  that  has  been  raised  to  a  boil. 

Boil  dish  cloths  frequently. 

Protect  all  food  from  flies  by  gauze  or  wire  netting  and  do  not 
place  it  upon  the  table  in  advance  of  the  meal  hour. 

Keep  the  kitchen  and  mess-room  scrupulously  clean,  carefully 
removing  scraps  of  food  and  particles  of  refuse  likely  to  draw  flies. 

Wash  your  hands  before  entering  the  mess-room. 

Keep  all  slops  and  garbage  in  closed  garbage  cans. 

Take  special  care  of  sinks  if  sewerage  or  incinerators  are  not  used. 

The  prophylactic  inoculation  of  a  live  culture  of  the  comma  bacil* 
lus,  or  cholera  vaccination,  first  introduced  by  Haffkine,  of  late 
years  practised  on  a  large  scale  in  India,  and  more  recently  in  some 
of  the  belligerent  armies  in  Europe,  has  given  highly  favorable 
results  and  proved  an  efficient  weapon  against  the  spread  of  this 
dreadful  scourge.  Strong's  cholera  autolysate  is  also  efficient. 


CHAPTER  IV. 
INFECTIOUS  DISEASES  (CONTINUED). 

TUBEBCULOSIS. 

Tuberculosis,  in  time  of  peace,  in  armies  as  in  civil  life,  causes 
more  deaths  than  any  other  disease.  During  the  three  years  1904-6, 
its  average  annual  mortality  among  American  troops,  in  the  United 
States  and  colonies,  was  0.67  per  thousand.  During  the  years  1909, 
1910  and  1911,  the  death  rate  was  0.57,  0.28  and  0.44  respectively. 
For  these  years  the  rates  of  admission  averaged  4.04  in  the  United 
States  and  4.76  in  the  Philippines.  For  the  two  years,  1914  and 
1915,  the  death  rate  was  0.47  and  0.33  respectively.  Inasmuch  as 
all  cases  originating  in  our  tropical  possessions  are  promptly  re- 
turned to  the  United  States,  it  is  difficult  to  ascertain  what  differ- 
ence, if  any,  there  might  be  in  the  death  rate.  From  the  experience 
of  our  Medical  Corps  it  seems  fair  to  conclude  that,  with  good 
hygienic  surroundings,  the  number  of  cases  is  not  materially  greater 
in  our  tropical  colonies  than  at  home,  but  that  they  progress  more 
rapidly  to  a  fatal  termination. 

In  the  U.  S.  Navy  and  Marine  Corps  the  death  rate  averaged 
0.58  for  the  years  1905  and  1906;  for  the  years  1910  and  1911  it 
was  0.33  and  0.59,  respectively. 

The  death  rates  for  tuberculosis  in  foreign  armies,  as  given  by 
the  last  available  reports,  are:  Great  Britain  (1909),  0.31;  France 
(1907),  0.76;  Prussia  and  Bavaria  (1907),  0.20;  Austria  (1909), 
0.45;  Russia  (1908),  0.58;  Japan  (1909),  0.34.  In  comparing 
these  rates  with  our  own,  it  is  necessary  to  remember :  first,  that 
whereas  in  European  armies  soldiers  found  suffering  from  tubercu- 
losis are  at  once  discharged,  in  our  Army  and  Navy  they  are  kept  a 
variable  period  of  time  under  treatment  in  sanatoria,  during  which 
they  continue  to  be  credited  to  the  Army  and  Navy  rates;  second, 
that  our  colored  troops,  which  form  5  to  6  per  cent,  of  the  Army, 
always  furnish  a  tuberculosis  death  rate  much  greater  than  that  of 
our  white  soldiers. 

For  the  3  years  1909-1911,  tuberculosis,  in  our  Army,  caused 
annually  16  per  cent,  of  all  deaths  from  disease.  For  all  adults 
from  20  to  29  (males  and  females)  in  the  United  States,  during 

54 


INFECTIOUS   DISEASES    (CONTINUED).  55 

1910,  the  nearest  class  corresponding  to  the  military  age,  tubercu- 
losis caused  35  per  cent,  of  all  deaths. 

If  we  compare  our  census  reports  with  those  of  the  Registrar 
General  of  England  and  Wales  for  the  period  1901-5,  it  appears  that 
the  mortality  rate  of  the  United  States  for  tuberculosis  averages  70 
per  100,000  of  population,  which  is  greater  than  that  of  England, 
Scotland,  Italy,  Spain,  Belgium  and  Japan,  but  smaller  than  that  of 
Germany,  France  and  Austria.  In  this  connection,  we  must  also 
bear  in  mind  the  great  susceptibility  of  the  colored  race  to  tubercu- 
losis, furnishing  a  rate  three  times  as  high  as  that  of  the  white,  so 
that,  were  the  white  population  alone  considered,  the  tuberculosis 
mortality  in  the  United  States  would  compare  very  favorably  with 
that  of  most  civilized  countries. 

Not  only  is  tuberculosis  the  most  deadly  disease  in  the  Army,  but 
also  that  which,  for  the  decade  1901-1910,  caused  the  highest  rate  of 
discharges;  the  next  highest  rate  being  caused  by  venereal  diseases. 

At  first  thought  it  would  seem  that  in  our  Army,  where  all  the 
men  are  carefully  examined  and  selected,  tuberculous  recruits  could 
be  entirely  excluded.  But  this  has  been  shown  to  be  impracticable. 
Men  may  carry  the  bacillus  in  a  latent  or  passive  form  (in  the 
lymphatic  nodes,  for  instance),  only  awaiting  such  determining 
causes  as  are  encountered  in  the  military  service  to  light  up  an  active 
process;  or  else  the  infection  is  in  such  incipient  stage  as  not  to  be 
recognized  by  the  ordinary  methods  of  examination.  It  is  well 
known  that  a  majority  of  cases,  in  all  armies,  are  first  taken  sick  in 
the  first  six  months  of  service,  too  soon  after  leaving  their  homes 
to  ascribe  their  infection  to  military  conditions.  A  certain  propor- 
tion of  recruits,  therefore,  whether  conscripted  or  voluntarily  en- 
listed, although  carrying  the  organisms  of  tuberculosis,  will  be 
accepted.  Cornet  estimates  this  unavoidable  percentage  for  the 
German  Army  at  0.42  per  cent.  From  the  records  of  the  Fort 
Bayard  sanatorium,  it  seems  quite  likely  that  a  large  proportion  of 
the  soldiers  who  die  there  of  tuberculosis,  or  are  discharged  on  ac- 
count of  it,  had  contracted  it  before  enlistment.  Thus  Bushnell 
found  that,  of  the  89  patients  discharged  for  pulmonary  tuberculosis 
from  January  I  to  August  31,  1906,  much  more  than  one-half  had 
been  examined  for  enlistment  or  reenlistment,  and  passed  as  sound, 
only  about  one  year  before  their  admission  to  the  sanatorium,  too 
short  a  period  to  dispel  a  strong  presumption  that  they  were  already 


56  MILITARY    HYGIENE. 

infected  at  that  time.  In  his  report  for  1911,  the  Surgeon  General 
states  that  of  all  cases  of  tuberculosis  treated  during  the  year,  74 
per  cent,  were  below  the  standard  proportion  of  weight  to  height, 
and  18  per  cent,  below  the  minimum  allowed  for  each  height. 

The  conclusions  drawn  by  Bushnell  from  the  recent  work  of 
German  investigators  (Military  Surgeon,  Jan.,  1913)  must  need 
cause  a  decided  change  in  our  views  of  tuberculosis  infection  and 
prophylaxis.  According  to  these  conclusions,  all  or  nearly  all  civil- 
ized adults  have  come  in  contact  with  the  tubercle  bacillus  and  been 
more  or  less  infected  in  childhood,  an  infection  which  has  the  effect 
of  vaccination,  producing  an  immunity  to  subsequent  outside  infec- 
tion. Inasmuch  as  these  adults  remain  constantly  exposed  to  the 
bacillus,  they  are,  as  it  were,  continuously  revaccinated.  The  ex- 
periments of  Franz,  of  the  Austrian  Army,  bear  upon  this  question. 
He  found  that  61  per  cent,  of  apparently  healthy  soldiers  from  a 
crack  regiment  reacted  distinctly  to  tuberculin.  It  is  now  believed 
that  a  much  greater  proportion  would  have  reacted  had  he  used  a 
larger  dose  of  tuberculin.  This  means  that  a  vast  majority  of 
adults,  therefore  of  soldiers,  harbor  live  tubercle  bacilli  in  their 
lymphatic  glands,  where  they  are  reduced  to  a  latent,  innocuous 
state  by  the  processes  of  immunity.  No  further  harm  from  without 
is  to  be  apprehended ;  the  danger  is  from  within,  when,  under  de- 
pressing influences,  there  is  a  breaking  down  of  the  immunization 
and  an  invasion  of  the  lungs  or  other  tissue. 

The  infectious  organism,  Bacillus  tuberculosis,  is  a  minute,  color- 
less rod,  with  regular  outlines  and  slightly  rounded  ends,  about  five 
times  as  long  as  it  is  thick.  As  found  in  sputum  it  varies  in  length 
from  one-fourth  to  one-half  the  diameter  of  a  red  blood-cell. 

It  is  chiefly  excreted  in  the  sputum  or  spittle  of  the  patient,  so  that 
his  expectoration  for  24  hours  contains  billions  of  it.  It  sometimes 
escapes  in  the  urine  and  feces  which,  in  advanced  cases,  may  thus 
infect  clothing  and  bedding,  as  well  as  the  hands  of  the  unclean. 
It  is  destroyed  in  water  or  milk  at  a  temperature  of  150°  F.,  main- 
tained for  20  minutes,  but,  like  that  of  typhoid  fever,  not  by  any 
degree  of  cold.  In  dry  sputum,  exposed  in  thin  layers  to  the  direct 
sunlight,  bacilli  lose  their  vitality  in  a  few  hours,  and  much  more 
quickly  if  the  sputum  is  in  the  shape  of  floating  dust,  but  may  resist 
several  days,  even  in  dust,  if  only  subjected  to  diffused  light.  In 
thick  masses  of  sputum,  in  which  the  coagulation  of  the  outer  sur- 


INFECTIOUS   DISEASES    (CONTINUED).  57 

face  forms  a  protective  covering,  the  bacillus  may  remain  alive 
several  months. 

Mode  of  infection. —  The  chief  avenue  of  infection  in  tubercu- 
losis was,  until  recently,  held  to  be  the  respiratory  tract,  in  view  of 
the  fact  that  the  lungs  are  the  parts  generally  most  affected.  Cornet 
and  his  school  taught  that  the  dried,  pulverized  tuberculous  sputum, 
suspended  with  the  dust  and  inhaled  in  breathing,  was  the  ordinary 
mode  of  infection.  This  doctrine  has  now  been  abandoned  on 
account  of  the  great  difficulty,  if  not  impossibility,  of  pulverizing  a 
tough,  sticky  substance  like  sputum  into  a  sufficiently  tenuous  dust 
to  float  in  the  air  and  find  its  way  into  the  finest  ramifications  of  the 
bronchial  tubes.  The  experiments  of  Nagel,  Fliigge  and  others 
have  shown  conclusively  that  bacilli  are  not  easily  detached  from 
the  moist  surfaces  of  mucous  membranes ;  that  consumptive  patients 
do  not  expel  them  in  ordinary  breathing,  but  may  do  so  in  coughing, 
sneezing  and  loud  talking,  being  contained  in  the  spray  of  fine  drop- 
lets then  ejected  from  the  mouth.  But  such  spray,  as  observed  by 
Winslow,  seldom  extends  more  than  a  few  feet  in  front  of  the 
patient,  and  soon  falls  to  the  ground,  where  it  becomes  harmless. 
The  number  of  organisms  thus  expelled,  as  measured  per  cubic  foot 
of  air,  is  almost  infinitesimal,  so  that  the  danger  is  more  from  actual 
contact  with  the  spray  than  from  any  possible  aerial  infection.  The 
dust  lying  on  the  neglected  floors  of  wards  to  which  tuberculous 
patients  are  admitted  may  contain  enough  bacilli  to  be  dangerous, 
but  only  when  kept  in  circulation  so  as  to  be  inhaled  by  the  occupants 
in  sufficient  quantity,  a  very  unusual  condition. 

The  food  may  become  infected  with  the  tubercle  bacillus  in  many 
ways,  especially  through  flies  and  other  insects.  Not  only  do  flies 
carry  it  on  their  feet,  but,  as  in  typhoid  fever,  they  also  excrete  it. 
Spillman  caught  flies  in  the  spittoon  of  a  consumptive  and  found 
virulent  bacilli  in  their  intestinal  contents.  Fly  specks  have  been 
found  to  contain  them.  According  to  F.  E.  Lord,  flies  may  con- 
tinue to  excrete  living  bacilli  for  15  days  after  ingesting  them.  The 
tuberculous  patient  himself  is  a  source  of  great  danger,  for  his 
hands,  face,  beard  and  clothing  are  readily  contaminated  from 
sputum  and  fecal  matter,  and  he  may  convey  the  infection  to  every- 
thing he  touches,  especially  articles  of  food.  In  view  of  the  fact 
that  the  bacillus  of  bovine  tuberculosis  is  practically  identical  with 
the  human  bacillus,  and  capable  of  producing  tuberculosis  in  man, 


58  MILITARY    HYGIENE. 

milk  and  its  products  may  become  dangerous  vehicles  of  infection 
(see  Milk). 

The  contention  that  tuberculosis  very  rarely,  if  ever,  occurs 
through  direct  inhalation  of  the  bacillus  into  the  smaller  bronchi  and 
air-cells  was  confirmed  by  the  demonstrations  of  Aufrecht,  Calmette 
and  others  that  the  tuberculous  processes  in  the  lungs  always  have 
their  beginning  in  the  finer  capillaries,  and  not  in  the  finer  air  tubes, 
as  would  be  expected  if  the  latter  were  the  channels  of  transmission 
of  the  bacillus. 

According  to  our  best  authorities,  man  acquires  tuberculosis  by 
inhalation  and  deglutition.  By  inhalation  the  bacilli  (discharged 
with  the  spray  from  the  mouth  of  patients)  lodge  in  the  mouth  or 
naso-pharyngeal  cavities;  those  that  survive  pass  through  the 
mucous  membrane  into  the  lympathics  and  are  carried  to  the  nearest 
cervical  and  bronchial  glands.  By  deglutition,  probably  the  usual 
mode  of  infection,  the  bacilli  are  carried  with  the  food  into  the 
stomach  and  intestine;  the  survivors  penetrate  through  the  walls 
of  the  intestine  and  reach  the  mesenteric  glands.  In  the  lymph 
glands  the  bacilli  may  remain  latent  temporarily  or  permanently. 
Should  they  happen  to  overcome  the  resistance  of  the  gland  tissue 
they  find  their  way  into  the  veinules  or  the  thoracic  duct,  and  the 
right  heart,  from  which  they  are  carried  to  the  lung  capillaries,  the 
finest  and  most  complex  capillaries  of  the  body.  It  is  also  known 
that  they  may  reach  the  left  heart  and  thus  enter  the  general  circu- 
lation. The  recent  work  of  German  investigators  has  confirmed  the 
observations  of  Rosenberger  demonstrating  the  frequent  presence 
of  the  tubercle  bacilli  in  the  blood.  They  are  usually  quickly  de- 
stroyed in  the  arterial  blood,  but  when  abundant  or  the  vitality  of 
the  subject  is  much  lowered  and  the  power  of  resistance  lost,  they 
are  capable  of  invading  various  tissues.  Thus  there  is  no  doubt 
that  bone  and  joint  tuberculosis  is  always  hematogenic  in  its  origin. 

The  bovine  bacillus,  so  far  as  pulmonary  tuberculosis  is  concerned, 
is  of  little  importance,  but,  according  to  Park,  it  causes  10  per  cent, 
of  all  deaths  due  to  tuberculosis  outside  the  lungs,  while  in  children 
25  per  cent,  of  all  cases  involving  glands,  joints  and  bones  are  of 
bovine  origin  and  due  to  the  drinking  of  milk. 

Prophylaxis. —  If  the  doctrine  of  acquired  immunity  described 
above  is  accepted,  as  Bushnell  thinks  it  should  be,  place  and  contact 
infections,  for  adults,  become  practically  negligible  dangers.  There 


INFECTIOUS    DISEASES    ( CONTINUED)  . 


59 


is  no  special  need  of  separating  a  patient  from  his  home,  except  to 
secure  better  treatment.  The  prevention  of  tuberculosis  in  the 
Army  is  practically  reduced  to  the  maintenance  of  good  hygiene  of 
the  individual  and  his  surroundings,  above  all  an  abundant  supply 
of  fresh  air,  so  that  his  immunity  may  remain  effective.  But  even 
then,  there  will  always  be  a  certain  proportion  of  individuals,  chil- 
dren and  adults,  unprotected  or  only  imperfectly  immunized,  and, 
for  their  sake,  it  remains  necessary  to  observe  the  usual  precautions 
of  prophylaxis,  especially  a  reasonable  degree  of  isolation. 


FIG.  5. —  U.  S.  Army  General  Hospital,  Fort  Bayard,  N.  M.  Patients  sleep 
on  the  verandas  in  all  weathers  except  during  snow  or  rain  storms.  Note 
snow  on  roof  and  ground. 


Nothing  has  been  more  satisfactorily  proved  than  the  preventive 
and  curative  effect  of  fresh  air  in  tuberculosis ;  fresh  air  has  ac- 
cordingly become  the  prominent  factor  in  the  prophylaxis  and  treat- 
ment of  this  disease.  (Fig.  5.)  No  dormitory  should  contain  more 
beds  than  it  has  room  for;  this  is  the  first  principle  in  barrack 
hygiene,  but  one  still  insufficiently  appreciated  and  frequently  vio- 
lated by  the  responsible  authorities.  Each  man  is  entitled  to  a 


60  MILITARY    HYGIENE. 

minimum  of  60  square  feet  of  floor  space  and  720  cubic  feet  of  air 
space.  To  give  him  less  is  to  greatly  increase  his  chances  of  con- 
tracting infectious  diseases,  and  the  disastrous  effects  of  overcrowd- 
ing are  shown  in  no  more  striking  way  than  in  rising  rates  of 
tuberculosis.  But  it  is  not  enough  to  provide  sufficient  room ;  it  is 
also  necessary  to  supply  adequate  ventilation  so  that  each  man  will 
get  from  2,000  to  3,000  cubic  feet  of  fresh  air  every  hour,  without 
draft.  With  plenty  of  air  space  and  free  ventilation,  the  danger  of 
inhaling  enough  bacteria,  of  any  disease,  to  become  infected  is 
greatly  reduced  if  not  entirely  eliminated. 

We  may  fairly  assume  that,  in  each  company  and  barrack,  there 
are  or  may  be  at  any  time  one  or  more  individuals  in  the  infective 
stage  of  tuberculosis.  The  first  care  of  the  responsible  officers  must 
be  to  remove  all  such  cases  as  soon  as  recognized.  To  that  end  non- 
commissioned officers  should  be  instructed  to  regard  as  suspicious 
any  man,  especially  a  recruit,  with  an  habitual  morning  cough,  and 
to  send  him  to  the  surgeon  for  examination.  This  precaution  is  not 
only  on  account  of  danger  to  his  comrades,  but  also  that  he  may 
receive  the  benefit  of  proper  treatment  as  soon  as  possible.  Under 
existing  regulations,  cases  of  tuberculosis  are  discharged  on  certifi- 
cate of  disability  or  else,  if  they  so  desire  and  their  condition  permits, 
sent  to  the  Army  Sanatorium  at  Fort  Bayard,  N.  M.,  where  they 
may  be  discharged  from  the  service  but  kept  under  treatment  as 
beneficiaries  of  the  Soldiers'  Home.  The  high  altitude  of  the  region, 
its  equable  temperature,  dry  air  and  abundant  sunshine  are  the 
qualities  of  climate  which  make  this  sanatorium  most  suitable  for 
the  treatment  of  tuberculosis.  Its  chief  purpose  is  the  cure  or  arrest 
of  the  disease  in  incipient  and  moderately  advanced  cases,  but  it  also 
cares  for  advanced  cases,  the  beneficiaries  of  the  Soldiers'  Home. 
The  majority  of  the  patients  whose  disease  is  not  so  far  advanced  on 
admission  as  to  end  in  death  within  the  year,  have  their  lives  pro- 
longed indefinitely.  Too  often,  however,  the  disease  is  only  dis- 
covered during  an  exacerbation  due  to  the  breaking  down  of  the 
tubercle,  and  when  already  too  far  advanced  to  expect  the  best 
results.  The  remoteness  of  this  sanatorium  from  the  majority  of 
posts  is  its  main  objection  ;  should  a  patient  be  subjected  to  the  neces- 
sary journey  of  3  or  4  days  while  in  a  high  febrile  condition,  he  may 
lose  irrecoverable  ground;  such  patients,  before  undertaking  the 
journey,  should  be  kept  in  bed  until  the  fever  abates.  Compara- 


INFECTIOUS   DISEASES    (CONTINUED).  6 1 

tively  few  men,  when  cured,  are  returned  to  duty,  for  the  reason  that, 
by  that  time,  there  is  generally  such  a  small  fraction  of  his  period 
of  enlistment  left  that  it  is  deemed  better  to  discharge  him  than 
subject  him  to  the  mortification  of  being  looked  upon  in  his  com- 
pany as  an  object  of  suspicion. 

The  result  of  treatment  in  358  "  completed "  cases,  as  reported 
in  1911,  was  as  follows:  Of  212  incipient  and  moderately  advanced 
cases,  12  were  cured,  16  arrested,  147  improved,  30  unimproved  and 
7  died.  Of  146  far  advanced  cases,  I  was  arrested,  88  improved, 
27  unimproved  and  30  died. 

A  similar  sanatorium  for  the  Navy  and  Marine  Corps  has  also 
been  established  at  Las  Animas,  Colo.,  and  another  for  the  Public 
Health  Service  at  Fort  Stanton,  N.  M. 

An  altitude  of  a  few  thousand  feet  is  favorable  to  most  patients 
but  detrimental  to  some.  The  question  of  climate  is  not  as  important 
as  formerly  believed,  and  it  is  now  generally  recognized  that  most 
of  the  advantages  of  a  sanatorium  can  be  obtained  at  home  by 
securing  plenty  of  fresh  air,  day  and  night,  rest  of  body  and  mind, 
and  suitable  food. 

Since  the  bacilli  are  spread  through  the  sputum,  strict  rules  must 
be  enacted  and  enforced  against  the  habit  of  promiscuous  expectora- 
tion, a  habit  as  dangerous  as  it  is  loathsome.  Spittoons  should  be 
provided,  partly  filled  with  a  disinfectant  solution,  and  anybody 
found  guilty  of  fouling  the  floor,  walls  or  furniture  of  his  squad- 
room  or  dormitory  with  his  expectoration,  mercilessly  dealt  with. 
But,  as  in  everything  else  when  dealing  with  intelligent  men,  more 
is  accomplished  by  appealing  to  the  understanding  than  by  threat  of 
punishment.  All  enlisted  men  should  receive  such  primary  instruc- 
tion in  practical  hygiene  from  their  company  officers  or  medical 
officers,  as  to  know  the  principal  diseases  to  which  they  are  exposed 
and  the  measures  to  take  to  avoid  them.  In  this  way  each  man  is 
interested  in  contributing  to  the  general  good  health  of  his  company 
and  post.  All  apartments  which  have  been  occupied  by  cases  of 
tuberculosis  must  be  thoroughly  disinfected.  Clothing  and  bedding 
should  be  preferably  steamed  or  boiled.  In  the  case  of  a  barrack, 
or  other  large  room,  fumigation  is  of  doubtful  utility  since  aerial 
infection  is  a  negligible  factor  in  the  etiology  of  tuberculosis,  but 
it  should  be  thoroughly  ventilated,  and  the  floor,  woodwork  and 
furniture  wiped  with  a  solution  of  formalin,  phenol  or  lysol. 


62  MILITARY    HYGIENE. 

PNEUMONIA. 

Next  to  tuberculosis,  pneumonia  is  the  most  deadly  of  all  diseases 
in  the  U.  S.  Army.  It-  occurs  in  all  climates  but  is  much  less  com- 
mon in  tropical  than  in  temperate  or  cold  countries.  For  the  entire 
Army,  at  home  and  abroad,  during  the  decade  of  1900-1909,  the 
yearly  mean  death  rates  per  thousand  of  strength  were  0.70  for 
tuberculosis  and  0.42  for  pneumonia;  they  have  steadily  decreased 
these  latter  years,  especially  for  the  former  disease,  so  that  for  the 
period  1908-1910  they  stand  0.44  and  0.36  respectively. 

The  usual  etiological  organism  of  pneumonia,  whether  of  the 
croupous,  catarrhal  or  septic  type,  is  the  Diplococcus  pneumonia:  or 
Pneumococcus,  a  rather  large,  lancet-shaped  coccus,  occurring  in 
pairs,  and  surrounded  by  a  definite  capsule.  It  is  frequently  found 
in  the  secretions  of  the  buccal  and  nasal  cavities  of  healthy  persons, 
producing  infection  only  when  acquiring  a  certain  degree  of  viru- 
lence, in  a  subject  with  lowered  resistance.  It  may  also  cause 
(generally  as  complications  of  pneumonia)  pleurisy,  pericarditis, 
endocarditis  and  meningitis.  Other  organisms  are  also  concerned 
in  the  causation  of  pneumonia,  chiefly  streptococci  and  the  bacilli  of 
influenza  and  of  Friedlander. 

In  dry  sputum  the  pneumococcus  may  remain  alive  and  virulent 
2  or  3  weeks  when  exposed  to  diffused  light.  In  finely  divided 
sputum,  such  as  ejected  in  coughing,  it  survives  only  one  or  two 
hours.  Exposed  to  strong  sunlight  it  dies  in  a  few  minutes.  It 
is  very  sensitive  to  heat  and  readily  destroyed  by  the  usual  germicidal 
agents. 

Pneumonia  occurs  most  frequently  in  crowded,  dark  and  ill- 
ventilated  dwellings.  The  habitual  breathing  of  vitiated  air  ren- 
ders the  lungs  especially  vulnerable  and  increases  the  chances  of 
infection. 

This  disease  is  not  very  contagious,  but  can  doubtless  be  trans- 
mitted by  the  particles  of  sputum  discharged  in  coughing  or  expecto- 
rating. It  is  best  to  isolate  the  patient  and  disinfect  the  sputum 
as  well  as  all  articles  which  come  in  contact  with  his  lips  and  mouth. 


CHAPTER   V. 
INFECTIOUS   DISEASES    (CONTINUED). 

MALARIA. 

Malarial  fever,  intermittent  fever,  ague,  chills  and  fever,  are  dif- 
ferent names  for  the  same  disease.  Formerly  ubiquitous  in  the 
inhabited  parts  of  the  United  States,  it  has  of  late  years  lost  much 
of  its  importance  and  is  still  steadily  decreasing  in  prevalence  and 
severity,  the  rate  of  admission  for  1911  being  only  14.68,  or  less 
than  half  that  of  1907  (30.20)  shown  in  Fig.  6.  For  the  years  1914 
and  1915  the  rate  was  10.74  and  12.37  respectively.  Not  a  single 


RATE  I  JAN   FEB   MAR   APR  MAY   JUN   JUL 


•B  Year  19O7.  Year  1885.  Decade  1875-84. 

FIG.  6. —  Diagram  illustrating  the  distribution  of  cases  of  malarial  fever 
by  months  per  thousand  strength,  in  the  United  States  Army  at  home.  Also 
showing  their  constant  reduction. 

death  from  malarial  fever  occurred  in  the  Army  in  the  United 
States  from  1906  to  1915  (in  which  year  two  deaths  were  reported). 
This  continuous  improvement  is  due  not  alone  to  the  active  efforts 
of  medical  officers  but  also  to  the  liberal  provision  for  wire-gauze 
screens  to  protect  doors  and  windows  made  by  the  Q.  M.  Corps. 

63 


64  MILITARY    HYGIENE. 

In  the  Philippines,  the  rate  of  admission  for  American  troops  has 
likewise  steadily  fallen  from  167.79  for  1907  to  75.56  for  1911,  but 
rose  again  to  171  in  1912  and  112  in  1913,  with  a  marked  drop  to 
45  in  1914.  In  1915  malarial  fever  still  stands  third  among  causes 
of  admission  and  non-effectiveness,  that  is,  next  to  venereal  diseases 
and  dengue.  Our  troops  in  the  colonies  being  now  mostly  com- 
fortably quartered  in  permanent  posts  where  preventive  measures 
against  mosquitoes  can  be  efficiently  carried  out,  it  is  confidently 
expected  that  the  rates  of  malarial  fever  will  continue  to  show  a 
steady  decrease. 

Malaria  is  an  Italian  word  meaning  bad  or  poisonous  air,  from 
the  belief  that  the  disease  was  caused  by  emanations  from  the  soil. 
It  is  now  generally  recognized  that  it  results  only  from  the  biting  of 
certain  species  of  mosquitoes,  and  that  soil  or  water  are  not  directly 
concerned  in  its  etiology.  (See  under  Mosquitoes,  page  159.) 

Parasites. —  In  the  act  of  stinging,  while  sucking  blood,  the  mos- 
quito injects  saliva  into  the  puncture  and,  if  infected,  the  germs  or 
parasites  of  malaria  are  carried  along  with  the  saliva.  These  para- 
sites are  microscopic  animalcules,  of  the  class  sporozoa,  genus  Plas- 
modium,  found  in  the  red  blood-cells.  They  were  described  by 
Laveran,  in  1880,  but  the  first  definite  mosquito-malaria  theory  was 
formulated  by  Manson  in  1894  and  demonstrated  by  Ross  in  1898. 

It  is  generally  accepted  that  each  form  of  malaria  is  produced  by 
a  distinct  variety  or  species  of  parasite.  The  best  classification  of 
the  malarial  plasmodia,  according  to  Craig,  is  as  follows : 

1.  Quartan  parasite  (Plasmodium  malaria). 

2.  Tertian  parasite  (P.  vivax}. 

3.  Estivo-autumnal  tertian  parasite  (P.  falciparum). 

4.  Estivo-autumnal    quotidian    parasite     (P.    falciparum    quoti- 
dianum). 

They  are  divided  into  two  groups,  the  benign  and  the  malignant. 
The  benign  parasites  are  two:  the  quartan,  with  cycle  of  72  hours 
in  the  human  body  and  causing  a  fever  recurring  every  3  days,  and 
the  tertian,  with  cycle  of  48  hours,  causing  a  fever  recurring  every 
2  days.  They  are  morphologically  distinguished  by  not  forming 
crescents  and,  clinically,  by  comparatively  mild  types  of  fever,  easily 
controlled  by  quinine.  The  malignant  parasites  are  the  estivo- 
autumnal  tertian,  with  cycle  of  approximately  48  hours,  and  the 
estit'0-autumnal  quotidian  (a  sub-species),  with  cycle  of  approxi- 


MILITARY  HYGIENE— HAVARD 


PLATE  V. 


1.  Estivo  —  autumnal  plasmodium;  young  or  ring  forms. 

2.  Estivo  —  autumnal  plasmodium;  sporulating  parasite. 

3.  Estivo  —  autumnal  plasmodium;  free  spores  or  merozoites. 

4.  Estivo  —  autumnal  plasmodium  ;  phagocytosis  of  sporulating  parasite. 

5.  Estivo  —  autumnal  plasmodium  ;  female  gamete  or  crescent. 

6.  Estivo  —  autumnal  plasmodium;  male  gamete  or  crescent. 


INFECTIOUS    DISEASES    (CONTINUED).  65 

mately  24  hours.  Craig  has  not  been  able  to  demonstrate  the  exist- 
ence of  a  pigmented  and  unpigmented  quotidian  plasmodium  as 
specifically  distinct  forms,  "  for  while  it  is  not  uncommon  to  observe 
only  unpigmented  quotidian  plasmodia  in  the  peripheral  blood  in 
estivo-autumnal  infections,  the  spleen  invariably  shows  pigmented 
organisms."  The  malignant  parasites  are  very  much  smaller  than 
the  benign  ones,  frequently  causing  the  invaded  blood-cells  to  become 
shrivelled,  crenated  and  to  assume  a  dark  "  brassy "  color,  but 
are  chiefly  distinguished  by  their  assuming  the  shape  of  crescents. 
Clinically,  they  give  rise  to  fevers  of  very  irregular  course  and  often 
of  pernicious  type,  over  which  quinine  has  but  little  effect. 

Whatever  its  species,  the  parasite  exhibits  two  distinct  phases  or 
cycles,  one  inside  the  human  body  and  one  in  the  body  of  the  mos- 
quito, both  cycles  being  necessary  to  its  full  sexual  development  and 
perpetuation. 


FIG.  7. —  Evolution  of  the  tertian  parasite,  stained.     (Manson.) 

Human  cycle. —  If  the  blood  is  examined  microscopically  shortly 
after  a  malarial  paroxysm  (Fig.  7),  some  cells  may  be  found  con- 
taining the  young  parasite,  in  the  form  of  an  ill-defined,  pale, 
roundish  body  showing  active  movements ;  scattered  through  it  are 
fine  granules  of  reddish-black  pigment  (f.  g.)  ;  after  a  while  these 
granules  collect  into  groups  or  lines  (h,  i,  j,  a)  ;  still  later,  the  body 
of  the  parasite,  which  fills  the  cell,  divides  into  segments  which 
become  well-defined  spherules  arranged,  rosette-like,  around  the 
pigmented  center  (b).  The  blood-cell  now  breaks  down  and  the 
spherules  become  free  in  the  liquor  sanguinis  (c,  d).  It  is  at  this 
time  that  the  chill,  or  first  stage  of  the  attack,  takes  place,  due  proba- 
bly not  so  much  to  the  presence  of  the  spherules  as  to  that  of  some 
toxin  set  free  in  the  circulation.  Most  of  the  spherules  are  absorbed 


66 


MILITARY    HYGIENE. 


and  devoured  by  the  white  cells  (phagocytes)  but  some  escape,  attach 
themselves  to  other  red  blood-cells  which  they  contrive  to  enter  (e), 
and  begin  another  cycle  of  life.  The  malarial  parasite,  thus  exposed 
to  the  attacks  of  the  white  cells  of  the  blood  and  other  enemies. 
would  soon  disappear  from  the  human  body,  and  out  of  existence, 
did  it  not  have  means  of  propagating  itself  outside  the  body  and 
re-entering  it  afterward. 

It  has  been  seen  that  the  parasites,  in  reaching  maturity,  develop 
into  rosette-like  or  segmenting  bodies,  but  not  all  of  them;    some 


FIG.  8. —  Evolution  of  the  flagellated  body  from  the  crescent.     (Hanson.} 

develop  into  the  sexual  form  or  gametes.  The  gametes  are  spheri- 
cal in  benign  fevers,  looking  like  ordinary  large  intracellular  pig- 
mented  parasites,  and  crescent-shaped  in  the  malignant  fevers.  The 
latter  are  of  slow  development  and  found  only  after  a  week  or  ten 
days  of  malarial  infection;  they  are  readily  distinguished  by  their 
shape,  their  pigmented  center  and  the  convex  line  bridging  over  the 
concavity  (Fig.  8,  a).  In  the  human  body  the  gametes  do  not  pro- 
ceed any  further  in  sexual  development.  The  spherical  gametes 
seldom  last  long,  while  the  crescents  may  persist  for  months,  some- 
times disappearing  from  the  superficial  circulation  but  generally 
numerous  in  the  deeper  viscera. 

The  pigment  elaborated  in  the  parasite  is  hematin,  set  free  by  the 
decomposition  of  hemoglobin.  At  the  time  of  the  segmentation  of 
the  parasite  and  breaking  down  of  the  blood-cell,  this  pigment  is 
liberated  into  the  circulation.  W.  H.  Brown  has  shown  that  it  is  an 
active  factor  in  the  production  of  many  if  not  all  of  the  important 
changes  in  the  blood  that  characterize  the  various  forms  of  malaria, 
and  that  to  it  are  directly  referable,  at  least  in  part,  the  acute  and 
chronic  symptoms  of  this  disease. 


MILITARY  HYGIENE— HAVARD 


PLATE  V. 


I. 
2. 
3- 

4- 
5- 
6. 


Estivo  —  autumnal  plasmodium ;  young  or  ring  forms. 
Estivo  —  autumnal  plasmodium;  sporulating  parasite. 
Estivo  —  autumnal  plasmodium 
Estivo  —  autumnal  plasmodium 


free  spores  or  merozoites. 
phagocytosis  of  sporulating  parasite. 


Estivo  —  autumnal  plasmodium;  female  gamete  or  crescent. 
Estivo  —  autumnal  plasmodium  ;  male  gamete  or  crescent. 


INFECTIOUS   DISEASES    (CONTINUED).  67 

Mosquito  cycle. —  When  blood  containing  gametes  (spheres  or 
crescents)  has  been  sucked  by  certain  species  of  mosquitoes,  further 
changes  soon  take  place.  The  crescents  become  transformed  into 
spheres.  The  spheres  from  either  source,  benign  or  malignant,  can 
now  be  differentiated  into  two  kinds,  male  and  female.  The  former 
are  transparent  or  hyaline,  the  latter  are  filled  with  granular  pro- 
toplasm. In  the  male  sphere,  one  or  more  filaments  or  flagella 
(microgametes)  suddenly  grow  out  from  the  periphery.  These 
flagella  execute  characteristic  waving  and  lashing  movements  and 
often  succeed  in  breaking  loose  from  the  sphere.  Each  flagellum 
thus  set  free  enters  and  impregnates  a  granular  or  female  sphere 
(macro gamete}.  The  latter  soon  changes  shape,  becomes  pointed 
and  vermicular  and  moves  about  with  great  vigor.  It  finally  lodges 
in  the  walls  of  the  mosquito's  stomach  where  it  increases  in  size. 
Its  nucleus  and  protoplasm  divide  into  a  number  of  spherular  cells 
around  which  spindle-shaped,  spine-like  bodies  are  formed.  These 
bodies  or  "  sporozoites  "  become  loose  in  the  capsule  and  are  dis- 
charged into  the  stomach.  Thence  they  find  their  way,  through  the 
blood  circulation,  to  the  3-lobed  salivary  glands  lying  one  on  each 
side  of  the  forepart  of  the  thorax,  and,  as  stated  before,  are  injected, 
with  the  saliva,  into  the  animal  bitten  by  the  mosquito. 

It  appears,  from  what  has  been  said,  that  the  malarial  parasite 
undergoes  important  changes  when  passing  from  one  host  to  the 
other,  and  is  not  infective  until  these  changes  are  completed.  Thus 
a  man  bitten  by  an  infected  mosquito  does  not  develop  symptoms  of 
malaria  until  a  week  or  ten  days  afterward,  and  probably  does  not 
become  infectious  to  another  mosquito  for  several  days  later.  The 
mosquito  which  has  become  infected  by  sucking  the  blood  of  a 
malarial  patient  is  not  dangerous  until  the  lapse  of  about  ten  days, 
or  until  the  sporozoites  have  matured  and  been  conveyed  to  the 
salivary  glands 

Prophylaxis. 

This  may  be  considered  under  the  following  heads : 

1.  Destruction  of  mosquitoes. 

2.  Protection  against  mosquito  bites. 

3.  Isolation  and  protection  of  malarial  patients. 

4.  Medical  prophylaxis. 


68  MILITARY    HYGIENE. 

The  first  three  means  of  prevention  are  entirely  based  on  our 
knowledge  of  the  role  played  by  the  mosquito  in  the  genesis  of 
malarial  fever.  Not  only  the  first,  but  the  second  and  third  as  well, 
if  carried  out  singly  with  completeness  for  a  couple  of  years,  would 
eliminate  malaria.  Thus,  were  all  healthy  men  protected  against 
mosquitoes,  no  new  cases  of  infection  would  be  possible;  likewise, 
were  all  malarial  patients  so  protected  that  no  mosquitoes  could  get 
at  them  and  become  infected,  the  disease  would  necessarily  come  to 
an  end.  But  it  is  evident  that  much  better  and  quicker  results  can 
be  obtained  by  a  combination  of  these  means. 

1.  Destruction  of  mosquitoes. —  This  is  sometimes  possible,  in  one 
or  two  seasons,  by  intelligent  concerted  action  between  individuals, 
or  with  adequate  financial  means  provided  by  State  or  municipality 
and  expended  under  the  supervision  of  experts.     Generally,  complete 
extinction,  in  civilized  countries,  is  only  the  result  of  steady  and 
progressive  cultivation  and  drainage  for  a  period  of  years.     But, 
fortunately,  long  before  such  result  is  obtained,  in  temperate  cli- 
mates, malarial  fever  will  have  practically  disaappeared ;  that  is  to 
say,  that  the  chances  of  contracting  it  decrease  in  a  much  more  rapid 
ratio  than  that  of  the  reduction  of  mosquitoes,  on  account  of  the 
coincident  reduction  of  malarial  cases  from  which  the  mosquitoes 
are  infected.     There  is  therefore,  for  each  place,  what  may  be  called 
a  minimum   of   safety,   depending  upon   the   amount   of   infective 
material  accessible ;  for  instance,  two  or  three  anopheles  mosquitoes 
in  a  Filipino  village,  a  majority  of  whose  natives  carry  the  germs  of 
malaria,  are  much  more  dangerous  than  swarms  of  them  in  a  New 
England  town. 

Only  certain  species  of  mosquitoes  transmit  pathogenic  germs. 
Therefore  it  is  important  to  ascertain,  in  each  locality,  whether  those 
species  are  present  and,  if  so,  to  study  their  habits  and  places  of 
breeding.  As  a  rule,  however,  different  species,  innocent  and  guilty, 
will  be  found  breeding  together  under  the  same  circumstances  so  as 
to  make  it  difficult  and  often  impossible  to  discriminate  between 
them  in  our  warfare. 

2.  Protection  against  mosquito  bites. —  In  a  malarial  country,  or 
wherever  mosquitoes  are  prevalent,  the  mosquito-bar  is  indispensa- 
ble.    To  be  effective,  it  must  be  sufficiently  long  to  rest  upon  the  floor 
all  round  the  bed,  and  its  meshes  sufficiently  small  to  exclude  all  mos- 
quitoes.    The  regulation  mosquito-bar  (model  1912)  now  supplied 


INFECTIOUS   DISEASES    (CONTINUED).  69 

to  all  the  men  of  the  U.  S.  Army,  is  made  from  bobinette,  with  not 
less  than  182  meshes  to  the  square  inch  (i4x  13).  It  is  66  inches 
long  on  ridge  and  base,  and  61  fromrid^etobase.  The  triangles  are 
S9l/2  inches  long  on  ridge  and  64  on  base.  It  has  40  tapes  arranged 
in  pairs,  each  tape  1 1  inches  long  and  stayed  with  a  piece  of  muslin. 
(Fig.  9.)  It  is  intended  not  only  for  bedsteads,  but  also  for  shelter 
tents,  cots  and  couches  of  any  kind,  and  follows  the  lines  previously 
indicated  by  Vedder  of  the  Medical  Corps.*  This  excellent  bar  is 
open  to  the  objection  that  its  meshes  are  somewhat  too  large;  it  is 


\ 


FIG.  9. —  Regulation  Mosquito  Bar  (Model  1912).     For  single  bedsteads  and 

shelter  tents. 

the  opinion  of  most  observers  that,  in  order  to  exclude  all  mosqui- 
toes, the  meshes  should  not  be  less  than  16  to  the  inch.  The  mos- 
quito-bar requires  careful  handling;  a  hole  or  tear  makes  it  worse 
than  useless,  for  mosquitoes  will  get  in  and  be  caught  as  in  a  trap, 
unable  to  escape.  Its  careful  use  should  be  the  subject  of  strict 
disciplinary  measures. 

In  countries  where  malarial  or  other  mosquito-borne  diseases  pre- 
vail, or  are  apprehended,  thorough  prophylaxis  requires  also  that, 
so  far  as  practicable,  all  doors,  windows,  ventilators,  etc.,  should  be 
screened  with  wire  netting  so  that  mosquitoes  may  not  get  inside  of 
buildings.  Copper  or  other  rust-proof  wire  is  preferable ;  iron  wire 
should  receive  two  coats  of  good  paint.  There  are  few  barracks 

*  The  same  officer  has  also  devised  a  portable  mosquito  and  fly-proof  hut 
consisting  of  a  knock-down  frame  and  netting  structure,  9  feet  in  all  three 
dimensions. 


TO  MILITARY    HYGIENE. 

or  other  large  inhabited  structures,  however,  especially  in  the  tropics, 
which  can  be  so  completely  screened  as  to  be  mosquito-tight  and 
render  mosquito-bars  unneecessary.  Such  result  is  obtainable  only 
when  the  architect  plans  and  builds  with  this  end  in  view.  All  the 
new  buildings  in  the  Isthmian  Canal  Zone,  for  instance,  are  so 
constructed  as  to  admit  of  complete  screening,  and  it  has  been  shown 
that  this  can  be  accomplished  without  sacrificing  any  of  the  requisites 
of  air  space  and  ventilation.  (Fig.  10.) 


FIG.  10. —  Club-house  at  Culebra,  Panama,  showing  construction  for  thorough 
screening  against  mosquitoes. 

In  a  malarial  country  and  so  long  as  mosquitoes  are  about,  the 
soldier  should  be  protected  not  only  in  garrison,  but  also  in  camp 
and  in  the  field.  Under  these  circumstances  he  should  be  supplied 
with  a  mosquito-bar,  as  part  of  his  equipment,  just  as  certainly  as 
he  is  with  a  blanket  and  shelter-tent. 

3.  Isolation  and  protection  of  malarial  patients. —  As  soon  as  a 
man  suffers  from  febrile  symptoms  which  may  be  reasonably 
ascribed  to  malaria,  he  should  be  isolated  and  protected,  that  is  to 
say,  placed  in  a  screened  ward,  under  a  mosquito-bar,  so  that  no 
mosquito  can  have  access  to  him.  Should  the  development  of  the 
case  prove  it  to  be  not  malarial,  nothing  will  be  lost  by  these  pre- 
liminary measures. 

Unfortunately,  it  is  well  known  that  the  natives  of  malarial  dis- 


INFECTIOUS    DISEASES    (CONTINUED).  71 

tricts,  especially  in  tropical  countries,  become  more  or  less  immune 
to  the  disease,  and  that,  although  their  blood  contains  the  parasite, 
they  enjoy  a  fair  degree  of  health,  and  attend  to  their  usual  daily 
occupations.  In  certain  parts  of  the  Philippines,  and  in  the  Isthmus 
Canal  Zone,  more  than  half  of  the  natives  were  found  thus  infected, 
although  not  apparently  incapacitated  for  work.  These  immune 
natives  are  a  constant  and  widespread  menace  to  other  people,  espe- 
cially young  soldiers.  In  and  about  their  quarters  infected  mos- 
quitoes are  always  found,  so  that  to  visit  them,  especially  when  these 
insects  are  most  active,  in  the  evening  or  during  the  night,  is  to 
court  serious  danger.  Such  visiting  should  be  strictly  prohibited. 
For  this  and  other  reasons  which  suggest  themselves,  a  camp,  other 
things  being  equal,  should  never  be  pitched  in  the  immediate  vicinity 
of  native  villages. 

Before  establishing  a  post  or  cantonment  in  an  unknown  country, 
it  is  very  important  to  determine  whether  malarial  fevers  are  pres- 
ent or  not,  and,  if  so,  to  what  extent.  This  is  best  done  by  the 
examination  of  the  blood  of  natives  and  of  mosquitoes  for  the 
development  stages  of  the  plasmodia. 

From  what  precedes  it  may  be  deduced  that  the  prophylaxis  of  a 
post  or  camp,  in  a  malarious  district,  involves  likewise  that  of  the 
surrounding  communities;  much  can  be  done  in  that  direction  by 
education  so  as  to  secure  the  cooperation  of  all  concerned  and 
develop  an  appreciation,  even  by  the  poor  and  ignorant,  of  the 
advantages  of  screening,  mosquito-bars  and  quinine. 

Medical  prophylaxis. —  Two  medicines  have  been  recommended 
as  preventives  of  malaria,  arsenic  and  quinine.  The  prophylactic 
virtue  of  arsenic  is  very  doubtful,  and  the  drug  is  now  seldom  used 
for  the  purpose.  Quinine  is  a  well-known  specific  as  curative  and 
preventive.  Its  systematic  use  when  campaigning  in  malarious  dis- 
tricts will  always  considerably  reduce  the  number  of  admissions. 
It  should  be  supplementary  to  other  means  of  prophylaxis,  especially 
the  use  of  the  mosquito-bar,  and  not  take  their  place.  Where  only 
tertian  and  quartan  infections  prevail,  2  grains  (0.15  gram)  a  day 
is  sufficient.  Where  the  estivo-autumnal  form  occurs,  quinine 
should  be  given  in  larger  doses  at  longer  intervals,  no  less  than  15 
grains  (i  gram)  once  a  week.  Such  preventive  treatment  need  not 
be  continued  throughout  the  year,  but  only  during  those  months 
when  malaria  prevails. 


72  MILITARY    HYGIENE. 

Prompt  and  active  treatment  upon  the  first  manifestation  of  the 
infection  will  almost  always  prevent  the  development  of  the  malig- 
nant forms  of  plasmodia.  Small  daily  doses  should  be  given  for  at 
least  three  months  after  the  disappearance  of  acute  symptoms. 

The  researches  of  Bruin  Mitzmain,  Public  Health  Service,  appear 
to  have  proved  that  the  malaria  parasites  cannot  live  through  the 
winter  in  hibernating  mosquitoes,  and  that  man  is  the  sole  winter 
carrier  of  malarial  infection.  Therefore  it  follows  that  malaria 
can  be  practically  eradicated  in  any  community  in  one  year,  inde- 
pendently of  the  number  of  anopheline  mosquitoes,  by  proper  quinine 
treatment. 

As  it  is  very  probable  thai  me  immunity  of  natives  in  malarious 
districts  is  acquired  at  the  expense  of  a  certain  amount  of  energy 
and  vitality,  it  would  be  clearly  to  their  advantage  and  that  of  all 
people  having  intercourse  with  them,  should  they  be  subjected  to  a 
sufficiently  prolonged  course  of  quinine  to  get  rid  of  the  infectious 
parasite  and  cease  to  be  a  menace  to  their  ne^hbors. 

BLACKWATER     FEVER     (HEMOGLOBINTJRIC     OR     HEMATTJRIC 

FEVER). 

An  acute  disease  characterized  by  an  initial  chill,  fever,  bilious 
vomiting,  jaundice  and  hemoglobinuria.  The  urine  becomes  very 
dark,  sometimes  almost  black,  and,  as  the  paroxysm  subsides,  returns 
gradually,  through  shades  of  red,  to  its  normal  color.  It  is  fre- 
quently diminished  in  quantity  and  sometimes  suppressed.  The 
fever  may  be  intermittent,  remittent  or  continued. 

It  is  found  in  many  tropical  and  subtropical  countries,  as  well  as 
in  our  southern  States,  and,  as  a  rule,  is  most  prevalent  in  malarial 
regions.  The  exact  nature  of  it  has  not  yet  been  determined. 
Many  writers  consider  it  simply  a  manifestation  of  malarial  intox- 
ication in  subjects  who  have  suffered  grave  or  repeated  attacks  of 
malaria  with  marked  destruction  of  blood  globules.  Christophers 
and  Bentley,  in  India,  have  furnished  strong  evidence  in  favor  of 
this  view.  Other  investigators,  however,  maintain  that  the  two 
diseases  are  not  necessarily  connected,  that  blackwater  fever  may  be 
absent  where  pernicious  malaria  is  prevalent,  and  exhibit  itself  in 
patients  in  whom  the  plasmodium  parasite  cannot  be  found.  Sam- 
bon,  Blanchard  and  others  are  inclined  to  regard  it  as  a  specific 
disease,  like  the  hemoglobinuric  fevers  of  cattle  and  horses,  caused 


INFECTIOUS   DISEASES    (CONTINUED).  73 

by  a  protozoon  (probably  Bebesia)  which  has  hitherto  escaped  the 
search  of  the  microscope.  Quinine  has  also  been  incriminated,  but 
on  quite  insufficient  evidence.  Even  in  toxic  doses  it  never  produces 
hemoglobinuria  in  healthy  people,  but  in  patients  already  suffering 
from  the  first  stage  of  blackwater  fever  it  may  provoke  or  increase 
some  of  the  manifestations  of  that  disease. 

Since  blackwater  fever  is  mostly  observed  in  individuals  who 
have,  or  have  had,  malaria,  prophylaxis  should  consist  in  avoiding 
exposure  to  the  causes  of  malaria.  Quinine  is  indicated  if  plas- 
modium  parasites  are  present  in  the  blood,  not  otherwise. 

YELLOW    FEVER. 

The  home  of  this  dread  disease  appears  to  nave  always  been  the 
central  portion  of  the  American  Continent,  and  more  especially  the 
West  Indies.  From  such  endemic  foci  as  Vera  Cruz,  Havana, 
Kingston  and  Panama  it  has  been  carried  southward  as  far  as 
Buenos  Ayres,  and  along  the  Pacific  coast  from  Mexico  to  Peru. 
It  has  also  occasionally  visited  the  western  European  countries  and 
the  coast  of  Africa.  Most  of  the  Gulf  and  Atlantic  seaports  of  the 
United  States,  as  far  north  as  Providence,  have  been  repeatedly 
scourged  by  it,  New  Orleans  and  Philadelphia  being  the  two  great- 
est sufferers.  This  disease  caused  fearful  loss  of  life  in  all  the 
military  expeditions  to  the  West  Indies  during  the  last  two  centuries, 
and  compelled  the  English,  after  their  conquest  of  Havana  in  1763, 
to  return  that  city  to  the  Spaniards  in  exchange  for  Florida. 

Etiology. —  The  mode  of  transmission  of  yellow  fever  was 
unknown  until  the  year  1900,  when  a  commission  of  medical  officers 
from  the  United  States  Army,  consisting  of  Reed,  Carroll,  Agra- 
monte  and  Lazear,  appointed  to  investigate  tropical  diseases,  made 
one  of  those  brilliant  discoveries  which  mark  epochs  in  the  progress 
of  medical  science.  They  proved  that  yellow  fever  cannot  be  con- 
tracted by  contact  with  the  patient  or  his  effects ;  that  it  is  not 
conveyed  through  the  air  nor  through  food  or  drink,  but  is 
always  the  result  of  mosquito  bites.  They  supported  their  doctrine 
by  such  convincing  demonstrations  and  arguments  that,  in  spite 
of  strong  and  prejudiced  opposition,  it  was  promptly  accepted  by 
the  scientific  world.  So  far  as  now  known,  yellow  fever  is  trans- 
mitted by  only  one  species  of  mosquito,  Stegomyia  fasciata  (page 
166).  This  mosquito,  to  be  infected,  must  bite  a  patient  during  the 


74  MILITARY    HYGIENE. 

first  three  days  of  the  disease,  and  it  cannot  transmit  the  infection 
until  the  lapse  of  at  least  12  days  after  the  bite.  The  subcutaneous 
injection  of  blood,  or  blood  serum,  from  a  yellow-fever  patient 
into  a  non-immune  person  will  also  cause  an  attack  within  the  usual 
incubation  period. 

The  nature  of  the  specific  virus  transmitted  from  patient  to  mos- 
quito, and  from  the  latter  to  non-immunes,  remains  unknown. 
Whether  it  is  a  soluble  toxin,  a  bacterium  or  protozoon  has  not 
been  determined,  although  the  indications  strongly  favor  the 
protozoon  theory.  However,  if  it  be  an  organism,  vegetable  or  ani- 
mal, it  is  so  tenuous  as  to  be  ultra-microscopic,  beyond  the  power 
of  our  best  microscopes.  It  has  been  proved  that  blood  serum  from 
a  yellow-fever  patient  is  capable  of  conveying  the  disease  by  sub- 
cutaneous injection,  therefore  contains  the  specific  virus,  even  after 
being  passed  through  a  Berkefeld  filter  which  excludes  all  visible 
microbes. 

The  propagation  of  yellow  fever  obviously  requires  three  con- 
ditions :  preexisting  cases  of  the  disease,  Stegomyia  mosquitoes  and 
the  presence  of  non-immunes.  If  there  is  no  yellow  fever  in  the 
locality,  everything  else  may  be  disregarded.  If  in  a  town  with 
good  sanitary  service  there  are  but  few  cases,  properly  isolated, 
while,  on  the  other  hand,  the  Stegomyia  mosquitoes  are  not  common, 
the  danger  is  a  negligible  quantity. 

Prophylaxis. —  Our  full  knowledge  of  the  mode  of  transmission 
of  yellow  fever  has  robbed  this  disease  of  its  terrors  and  made  its 
prevention  a  comparatively  simple  matter.  It  has  already  disap- 
peared from  Cuba,  Vera  Cruz  and  Panama,  and  we  may  reasonably 
assume  that  it  will  be  practically  stamped  out  from  the  continent 
before  many  years  have  elapsed. 

The  rules  to  be  followed  suggest  themselves ;  it  is  mostly  a  ques- 
tion of  their  strict  and  efficient  application.  As  in  the  case  of 
malaria,  every  effort  must  be  made  to  destroy  the  mosquitoes  or  at 
least  reduce  their  number.  The  Stegomyia  is  a  domestic  insect, 
therefore  tanks  and  cisterns  should  be  protected  against  it,  and 
water  not  allowed  to  stand  in  gutters,  spouts,  tubs,  vases  and  other 
receptacles  in  or  about  dwellings.  It  is  a  twilight  mosquito,  feeding 
early  in  the  morning,  and  in  the  afternoon  and  evening  until  ten 
o'clock,  so  that  non-immunes  can  go  about  in  infected  localities 
between  9  A.  M.  and  3  P.  M.  with  almost  absolute  impunity  (C 


INFECTIOUS    DISEASES    (CONTINUED).  75 

Houses  should  be  screened,  so  far  as  it  is  practicable,  and  all  in- 
mates sleep  under  efficient  mosquito-bars.  As  soon  as  any  person 
(especially  if  non-immune)  in  an  infected  locality  experiences 
symptoms  of  fever  not  readily  accounted  for,  particularly  if  it 
begins  with  a  chill  and  headache,  he  should  at  once  be  isolated  and 
placed  behind  wire  screens  and  mosquito-bar.  Since  the  patient  is 
only  infectious  to  the  mosquitoes  during  the  first  three  days  of  the 
disease,  the  necessity  of  discovering  and  promptly  isolating  him,  in 
the  incipient  stage,  becomes  clearly  apparent.  As  soon  as  he  is 
removed  from  his  room,  and  before  the  mosquitoes  have  a  chance  to 
escape,  disinfection  must  follow.  As  the  only  pathogenic  germs 
are  in  the  bodies  of  infected  mosquitoes,  the  sole  object  of  this  dis- 
infection, or  rather  fumigation,  is  to  destroy  all  mosquitoes  in  the 
patient's  bedroom  and  adjacent  rooms  and  thus  remove  the  only 
cause  of  further  danger.  For  this  purpose,  the  fumes  of  pyrethrum 
powder,  campho-phenol  or  sulphur  are  used,  as  described  under 
Insecticides.  The  disinfection  of  the  patient's  person,  bedding, 
clothing  and  effects  is  entirely  unnecessary. 

The  natives  of  zones  where  yellow  fever  is  endemic  are  immune 
to  it.  This  is  attributed  to  the  effect  of  a  mild  form  of  the  infection 
which  they  are  supposed  to  have  had  in  infancy  and  childhood,  the 
so-called  borras  fever  of  the  Cubans.  All  non-immunes,  in  an 
infected  locality,  should  be  identified,  brought  together  as  much 
as  possible,  regularly  inspected  and  the  object  of  special  sanitary 
measures. 

From  the  day  a  man  is  taken  sick,  no  secondary  case  can  result 
before  the  lapse  of  at  least  14  days,  namely,  i  day  or  more  before 
the  secondary  mosquito  becomes  infected,  12  days  for  the  elabora- 
tion of  the  germ  in  its  body,  and  i  or  more  days  of  incubation  after 
biting  the  secondary  patient.  Therefore  if,  in  an  outbreak,  after 
a  lull  of  2  or  3  weeks,  a  new  crop  of  cases  appears,  the  presumption 
is  very  great  that  the  mosquitoes  infected  by  the  primary  crop,  or 
some  of  them,  are  still  at  large. 

The  incubation  of  yellow  fever  ranges  usually  from  3  to  4  days, 
so  that  a  quarantine  period  of  at  least  5  days  is  necessary.  Any 
person  suspected  of  having  been  exposed  to  the  bite  of  infected 
mosquitoes  should  be  kept  under  observation  until  5  days  have 
elapsed.  Ships  visiting  infected  ports  should  keep  away  from  other 
vessels  and  anchor  at  least  half  a  mile  from  shore.  See  Quarantine. 


76  MILITARY    HYGIENE. 

HISTORICAL  APPENDIX.  —  The  mosquito-malarial  theory  passed  from  the 
region  of  conjecture  to  that  of  fact  in  1900.  The  experiments  of  Ross, 
Grassi,  Sambon  and  others  had  been  closely  followed  by  the  medical  officers 
of  the  U.  S.  Army,  and  suggested  to  Reed  the  possible  agency  of  the  mos- 
quito in  the  transmission  of  yellow  fever;  nor  were  the  medical  officers, 
then  serving  in  Cuba,  slow  in  assuming  the  responsibility  of  recommending 
the  general  application  of  the  conclusions  reached  concerning  the  conveyance 
of  malarial  and  yellow  fevers.  As  early  as  Oct.  15,  1900,  Col.  J.  R.  Kean, 
then  Chief  Surgeon  of  the  Department  of  Western  Cuba,  made  the  following 
statement  in  a  communication  to  the  Adjutant  General  of  the  Department: 

"The  role  of  the  mosquito  in  the  transmission  of  certain  diseases  is  now 
well  established.  The  evidence  is  now  perfect  and  conclusive  that  malaria, 
as  well  as  filarial  infections,  are  carried  by  this  insect,  and  there  are  reasons 
to  suspect  that  it  may  be  connected  with  the  transmission  of  yellow  fever 
also." 

This  was  written  before  the  Reed  Board  had  published  the  results  of  its 
experiments ;  as  soon  as  these  were  completed,  upon  the  recommendation  of 
Col.  Kean,  then  acting  Chief  Surgeon  of  the  Department  of  Cuba,  the  follow- 
ing order  was  issued : 

GENERAL  ORDERS }  HEADQUARTERS  DEPARTMENT  OF  CUBA, 

No.  6.          j  Havana,  December  21,  1900. 

The  Chief  Surgeon  of  the  Department  having  reported  that  it  is  now  well 
established  that  malaria,  yellow  fever  and  filarial  infection  are  transmitted 
by  the  bites  of  mosquitoes,  the  following  precautions  will,  upon  his  recom- 
mendation, be  taken  for  the  protection  of  the  troops  against  the  bites  of  these 
insects : 

1.  The  universal  use  of  mosquito-bars  in  all  barracks  and  especially  in  all 
hospitals,  and  also  in  field  service  when  practicable. 

2.  The  destruction  of  the  larvae  or  young  mosquitoes,  commonly  known  as 
"  wiggletails "  or  "  wigglers,"  by  the  use  of  petroleum  on  the  water  where 
they  breed. 

The  mosquito  does  not  fly  far  and  seeks  shelter  when  the  wind  blows ;  so  it 
is  usually  the  case  that  each  community  breeds  its  own  supply  of  mosquitoes 
in  water  barrels,  fire  buckets,  post  holes,  old  cans,  cesspools,  or  undrained 
puddles. 

An  application  of  one  ounce  of  kerosene  to  each  fifteen  square  feet  of 
water,  twice  a  month,  will  destroy  not  only  all  the  young,  but  the  adult 
females  who  come  to  lay  their  eggs.  The  water  in  cisterns  or  tanks  is  not 
affected  for  drinking  or  washing  purposes  by  this  application  if  only  it  is 
drawn  from  below  and  not  dipped  out. 

For  pools  or  puddles  of  a  somewhat  permanent  character,  draining  or 
filling  up  is  the  best  remedy. 

The  Medical  Department  will  furnish  oil  for  the  purpose  above  mentioned. 

Post  commanders  will  carefully  carry  out  these  precautions. 

BY  COMMAND  OF  MAJOR  GENERAL  WOOD: 

H.  L.  SCOTT, 

Adjutant  General. 


INFECTIOUS   DISEASES    (CONTINUED).  77 

The  doctrine  that  it  is  unnecessary  to  isolate  yellow-fever  patients,  beyond 
screening  them  against  mosquitoes,  was  so  novel  and  startling  that  there  was 
considerable  hesitation  in  the  official  recognition  and  application  of  that 
great  and  far-reaching  discovery.  However,  the  irresistible  conclusions  of 
the  Reed  Board  having  soon  removed  all  doubts,  it  became  advisable  to  lay 
greater  emphasis  upon  the  new  measures  of  prophylaxis  required,  and  the 
Governor  General  ordered  the  publication  of  the  following  circular  prepared 
by  the  writer,  then  Chief  Surgeon  of  Cuba : 


CIRCULAR,  |  HEADQUARTERS  DEPARTMENT  OF  CUBA, 

No.  5.    (  Havana,  April  27,  1901. 

Upon  the  recommendation  of  the  Chief  Surgeon  of  the  Department,  the 
following  instructions  are  published  and  will  be  strictly  enforced  at  all  mili- 
tary posts  in  this  department : 

The  recent  experiments  made  in  Havana  by  the  Medical  Department  of 
the  Army  having  proved  that  yellow  fever,  like  malarial  fever,  is  conveyed 
chiefly,  and  probably  exclusively,  by  the  bite  of  infected  mosquitoes,  impor- 
tant changes  in  the  measures  used  for  the  prevention  and  treatment  of  this 
disease  have  become  necessary. 

1.  In  order  to  prevent  the  breeding  of  mosquitoes  and  protect  officers  and 
men  against  their  bites,  the  provisions  of  General  Orders  No.  6,  Department 
of  Cuba,  December  21,  1900,  shall  be  carefully  carried  out,  especially  during 
the  summer  and  fall. 

2.  So  far  as  yellow  fever  is  concerned,  infection  of  a  room  or  building 
simply  means  that  it  contains  infected  mosquitoes,  that  is,  mosquitoes  which 
have  fed  on  yellow  fever  patients.     Disinfection,  therefore,  means  the  em- 
ployment of  measures  aimed  at  the  destruction  of  these  mosquitoes.     The 
most  effective  of  these  measures  is  fumigation,  either  with  sulphur,  formal- 
dehyde* or  insect  powder.     The  fumes  of  sulphur  are  the  quickest  and  most 
effective  insecticide,  but  are  otherwise  objectionable.     Formaldehyde  gas  is 
quite  effective  if  the  infected  rooms  are  kept  closed  and  sealed  for  two  or 
three  hours.     The  smoke  of  insect  powder  has  also  been  proved  very  useful ; 
it  readily  stupefies  mosquitoes,  which  drop  to  the  floor  and  can  then  be  easily 
destroyed. 

The  washing  of  walls,  floors,  ceilings  and  furniture  with  disinfectants  is 
unnecessary. 

3.  As  it  has  been  demonstrated  that  yellow  fever  cannot  be  conveyed  by 
fomites,  such  as  bedding,  clothing,  effects  and  baggage,  they  need  not  be  sub- 
jected to  any  special   disinfection.     Care  should  be  taken,  however,  not  to 
remove  them  from  the  infected  rooms  until  after  formaldehyde  fumigation, 
so  that  they  may  not  harbor  infected  mosquitoes. 

Medical  officers  taking  care  of  yellow  fever  patients  need  not  be  isolated; 
they  can  attend  other  patients  and  associate  with  non-immunes  with  perfect 
safety  to  the  garrison.  Nurses  and  attendants  taking  care  of  yellow  fever 

*  It  was  soon  after  this  that  formaldehyde  was  shown  to  be  unreliable  as 
an  insecticide. 


78  MILITARY    HYGIENE. 

patients  shall  remain  isolated,  so  as  to  avoid  any  possible  danger  of  their 
conveying  mosquitoes  from  patients  to  non-immunes. 

4.  The  infection  of  mosquitoes  is  most  likely  to  occur  during  the  first  two 
or  three  days  of  the  disease.     Ambulant  cases,  that  is,  patients  not  ill  enough 
to  take  to  their  beds  and  remaining  unsuspected  and  unprotected,  are  probably 
those  most  responsible  for  the  spread  of  the  disease.     It  is  therefore  essential 
that  all   fever  cases   should  be  at   once  isolated  and  so   protected  that  no 
mosquitoes  can  possiblv  get  access  to  them  until  the  nature  of  the  fever  is 
positively  determined. 

Each  post  shall  have  a  "  reception  ward "  for  the  admission  of  all  fever 
cases  and  an  "isolation  ward"  for  the  treatment  of  cases  which  prove  to  be 
yellow  fever.  Each  ward  shall  be  made  mosquito-proof  by  wire  netting  over 
doors  and  windows,  a  ceiling  of  wire  netting  at  a  height  of  seven  feet  above 
the  floor,  and  mosquito-bars  over  the  beds.  There  should  be  no  place  in  it 
where  mosquitoes  can  seek  refuge  not  readily  accessible  to  the  nurse.  Both 
wards  can  'be  in  the  same  building,  provided  they  are  separated  by  a  mosquito- 
tight  partition. 

5.  All  persons  coming  from  an  infected  locality  to  a  post  shall  be  kept 
under  careful  observation  until  the  completion  of  five  days  from  the  time  of 
possible  infection,  either  in  a  special  detention  camp  or  in  their  own  quarters ; 
in  either  case,  their  temperature  should  be  taken  twice  a   day  during  this 
period  of  observation  so  that  those  who  develop  yellow  fever  may  be  placed 
under  treatment  at  the  very  inception  of  the  disease. 

6.  Malarial  fever,  like  yellow  fever,  is  communicated  by  mosquito  bites,  and 
therefore  is  just  as  much  of  an  infectious   disease  and  requires  the  same 
measures  of  protection  against  mosquitoes.     On   the   assumption   that  mos- 
quitoes remain  in  the  vicinity  of  their  breeding  places,  or  never  travel  far, 
the  prevalence  of  malarial  fever  at  a  post  would  indicate  want  of  proper 
care  and  diligence  on  the  part  of  the  surgeon  and  commanding  officer  in 
complying  with  General  Orders  No.  6,  Department  of  Cuba,  1900. 

7.  Surgeons  are  again  reminded  of  the  absolute  necessity,  in  all  fever  cases, 
to  keep,  from  the  very  beginning,  a  complete  chart  of  pulse  and  temperature, 
since  such  a  chart  is  their  best  guide  to  a  correct  diagnosis  and  the  proper 
treatment. 

BY  COMMAND  OF  MAJOR  GENERAL  WOOD: 

H.  L.  SCOTT, 

Adjutant  General. 

DENGUE. 

Dengue,  or  break-bone  fever,  is  an  acute  infectious  epidemic  dis- 
ease of  tropical  and  subtropical  countries.  It  has  frequently  pre- 
vailed in  the  Southern  States,  as  far  north  as  Charleston,  and 
occasionally  reached  Philadelphia  and  New  York.  Its  mortality  is 
very  small,  in  uncomplicated  cases  practically  nil. 

There  has  been  no  case  of  dengue  among  troops  in  the  United 


INFECTIOUS    DISEASES    (CONTINUED).  79 

States  during  the  last  few  years,  but  it  is  more  or  less  endemic  and 
of  considerable  military  importance  in  the  Philippine  Islands  on 
account  of  the  rapidity  of  its  spread  and  the  large  number  of  people 
infected  during-  an  outbreak.  It  is  there  one  of  the  important  causes 
of  admission,  the  annual  rate  for  the  period  1904-6  having  been 
about  60  per  thousand  of  strength,  and,  for  the  period  1909-1911, 
about  no.  As  it  is  hardly  ever  fatal  (only  i  death  during  the 
period  1909-1911)  and  has  a  very  small  non-effective  rate,  it  con- 
stitutes rather  an  inconvenience  than  a  sanitary  danger. 

Dengue  presents  much  analogy  to  yellow  fever  in  some  of  its 
peculiarities ;  it  only  prevails  in  warm  weather,  always  ceasing  with 
the  advent  of  winter  in  the  Southern  States,  and  spreads  most  read- 
ily along  the  coast  line,  seldom  extending  far  inland,  or  upward  to  a 
high  altitude. 

Nothing  definite  is  known  regarding  the  virus  of  this  disease,  but 
its  mode  of  propagation  seems  to  have  been  finally  settled  by  the 
experiments  of  Ashburn  and  Craig  (The  Military  Surgeon,  Septem- 
ber, 1907),  whose  conclusions  are  as  follows:  No  organism,  either 
bacterium  or  protozoon,  can  be  demonstrated  in  either  fresh  or 
stained  specimens  of  dengue  blood  under  the  microscope;  the  intra- 
venous inoculation  of  unfiltered  or  filtered  blood  into  healthy  men 
is  followed  by  a  typical  attack  of  the  disease;  the  disease  can  be 
transmitted  by  the  mosquito  Culex  fatigans  and  this  is  probably  the 
more  common  method  of  transmission ;  the  period  of  incubation  in 
experimental  cases  averaged  3  days  and  14  hours. 

Bancroft,  in  Australia,  also  concluded  that  the  germ  is  ultramicro- 
scopic,  but  that  it  was  conveyed  by  Stecfomyia  fasciata. 


CHAPTER    VI. 
INFECTIOUS  DISEASES    (CONTINUED). 

MALTA    FEVER. 
(Mediterranean  Fever.) 

A  continued  fever  of  complex  and  irregular  symptomatology, 
prolonged  and  indefinite  duration,  with  frequent  relapses,  undulat- 
ing thermal  curve,  sweats,  rheumatic  and  neuralgic  pains,  constipa- 
tion and  frequently  orchitis.  Mortality  low,  seldom  exceeding  2 
per  cent. 

Its  home  is  in  Malta  and  other  islands  of  the  Mediterranean,  as 
well  as  in  all  countries  (of  Europe,  Asia  and  Africa)  bordering  on 
that  sea,  but  has  extended,  in  sporadic  or  endemic  form,  to  most 
tropical  and  subtropical  countries,  including  the  southern  United 
States  and  the  Philippines.  It  was  doubtless  spread  by  the  exporta- 
tion of  goats  from  Malta  and  Asia  Minor  to  India,  South  Africa  and 
America.  Gentry  and  Ferenbaugh*  have  demonstrated  its  endemic 
existence  in  certain  goat-raising  sections  of  Texas  where  goats  were 
first  imported  from  the  Mediterranean.  They  found  that  about  20 
per  cent,  of  the  animals  examined  gave  a  positive  agglutination 
reaction,  although  showing  no  manifest  symptom  of  illness,  and  that 
several  herders  had  suffered  from  this  disease.  It  is  probable  that, 
in  those  regions,  many  cases  are  overlooked,  being  mistaken  for 
atypical  typhoid  fever. 

Malta  fever  is  caused  by  the  presence  in  the  blood  of  a  very  small 
coccus  (Micfococcus  melitensis)  found  in  all  the  organs,  especially 
the  spleen,  and  often  in  secretions  and  the  urine,  but  not  in  the 
feces.  It  enters  the  body  by  the  drinking  of  infected  milk,  or  by 
the  contact  of  the  urine  or  milk  with  mucous  membranes  or  the 
abraded  skin.  The  urine  may  act  indirectly  by  polluting  the  food 
or  contaminating  the  soil.  This  organism  possesses  great  power  of 
resistance,  having  been  recovered  from  khaki  cloth,  blankets  and 
serge  on  the  8oth  day. 

This  disease  may  affect  all  domestic  animals.     In  Malta  it  was 

*J.  Am.  Med.  Ass.,  Sept.  30,  1911. 

80 


INFECTIOUS   DISEASES    (CONTINUED).  8l 

found  to  be  propagated  mostly  through  the  milk  of  goats.  When 
cows  become  infected  their  milk  is  likewise  a  source  of  danger.  The 
diagnosis  can  only  be  positively  settled  by  hemoculture  at  the  hands 
of  an  expert,  or  by  the  agglutination  test.  The  Bureau  of  Animal 
Industry  found  that  serum  from  healthy  goats  may  give  an  aggluti- 
nation of  i  to  40;  hence  an  agglutination  of  at  least  i  to  70, 
within  one  and  a  half  hours,  is  required  for  positive  diagnosis. 

Prophylaxis  consists  chiefly  in  the  bacteriological  examination  of 
goat  herds  and  the  isolation  and  destruction  of  all  diseased  animals. 
The  flesh  of  infected  animals  can  be  consumed  with  impunity  if 
properly  cooked.  Their  milk  could  also  be  utilized  after  boiling. 

PAPATACI   FEVER. 
(Three-day  Fever,  Sandfly  Fever.) 

An  infectious  fever  of  short  duration,  never  fatal  but  attended 
with  marked  debility  and  causing  great  loss  of  time  in  the  military 
service  of  Austria  and  Italy.  It  prevails  in  the  basin  of  the  Adriatic, 
often  epidemically,  and  is  occasionally  found  in  all  other  countries 
bordering  on  the  Mediterranean  Sea.  It  is  also  reported  from 
North  India.  It  is  caused  by  the  bite  of  a  very  small  fly  (Phleboto- 
mus  papatasii).  (See  page  158.)  The  infective  organism  has  not 
yet  been  identified,  being  apparently  invisible  under  the  microscope 
and  passing  through  the  Berkefeld  filter. 

SIX-DAY  FEVER. 

Under  this  name,  Dr.  W.  E.  Decks*  has  described  a  febrile  dis- 
ease peculiar  to  the  Panama  Canal  Zone.  It  has  an  acute  onset  with 
chills,  headache  and  backache,  the  temperature  reaching  as  high  as 
104°  and  falling  to  normal  on  the  6th  day.  The  spleen  is  enlarged. 
Leucopenia,  with  high  percentage  of  polynuclears,  is  the  most  im- 
portant blood  change.  Albuminuria  is  almost  always  present.  A 
rash,  especially  on  the  extremities,  is  frequently  seen.  The  cause 
of  this  fever  has  not  been  determined. 

TYPHUS   FEVER,. 

An  acute,  very  infectious  epidemic  disease,  characterized  by  a 
profuse  roseola  and  petechial  eruption,  formerly  causing  a  fearful 

*J.  Am.  Med.  Ass.,  Oct.  26,  1912. 


82  MILITARY    HYGIENE. 

mortality  in  many  parts  of  Europe,  especially  in  camps  and  along 
trails  of  armies.  Outbreaks  have  been  rare  in  the  United  States  and 
easily  controlled,  always  resulting  from  imported  cases.  The  dis- 
ease is  still  endemic  in  several  countries,  especially  Austria-Hungary 
(more  particularly  in  Galicia),  Russia,  the  Balkan  countries,  Great 
Britain  and  Ireland.  The  last  epidemics  of  it  were  in  the  Turco- 
Russian  War  of  1878,  and  in  Servia  in  1915.  Many  sporadic  cases 
were  found  in  most  of  the  Russian  base  hospitals  during  the  Russo- 
Japanese  War,  and  outbreaks  of  it  were  frequent  in  the  belligerent 
armies  during  the  first  year  of  the  European  War. 

It  has  long  been  observed  that  typhus  fever  is  not  spread  by 
fomites  or  simple  direct  contact.  The  fact  that  it  usually  breaks  out 
in  crowded  tenements,  jails,  emigrant  ships  and  insanitary  camps  has 
long  pointed  to  the  probability  of  vermin  as  the  propagating  factor. 
Nicolle,  in  Tunis,f  transmitted  this  disease  to  monkeys  by  the 
injection  of  blood  from  human  patients,  and  then  from  monkey  to 
monkey  by  means  of  the  ordinary  body  louse.  Similar  experiments 
were  carried  on  by  Ricketts  and  Wilder, :£  who  transmitted  the  typhus 
fever  of  Mexico  (tabardillo)  to  man  and  monkey  through  the  same 
insect.  It  is  now  well  established  that  the  body  louse  and,  to  a 
lesser  extent,  the  head  louse,  are  the  usual  communicating  agents  of 
typhus  infection.  The  above  investigators  also  believed  that  the 
infectivity  of  the  louse  may  be  transmitted  from  one  generation  to 
the  next  by  heredity,  thus  facilitating  the  spread  of  the  infection 
in  space  and  time,  but  this  has  not  been  confirmed  by  the  later  re- 
searches of  Anderson  and  Goldberger.*  The  louse  is  infective 
until  the  5th  day  after  feeding  and  perhaps  later,  but  probably  not 
after  the  7th.  The  bedbug  and  flea  appear  to  be  incapable  of 
propagating  this  disease.  The  virus  is  present  in  the  blood  through- 
out the  febrile  period  and  for  a  day  or  two  after  the  return  of  the 
temperature  to  normal.  There  is  no  evidence  that  it  is  capable  of 
passing  through  a  Berkefeld  filter. 

Anderson  and  Goldberger  were  unable  to  produce  typhus  in  mon- 
keys by  the  injection  of  the  buccal  and  pharyngeal  secretions  from 
human  cases,  and  therefore  express  the  opinion  that  it  is  not  trans- 
mittable  by  droplets  ejected  from  mouth  or  nose. 

t  J.  Am.  Med.  Ass.,  Feb.  5,  1910. 

t  J.  Am.  Med.  Ass.,  July  23,  1910. 

*  Collected  Studies  on  Typhus.     Hyg.  Lab.  Bull.  86,  1912. 


INFECTIOUS   DISEASES    (CONTINUED).  83 

A  peculiar  continued  fever,  known  as  Brill's  disease,  not  uncom- 
mon in  the  lodging  and  tenement  houses  of  our  large  cities,  has 
recently  been  identified  as  a  mild  form  of  typhus  fever.  Thus  an 
attack  of  it  immunizes  against  typhus  fever,  as  well  as  against 
tabardillo,  a  fact  which  also  proves  the  identity  of  these  two  dis- 
eases. Therefore  there  is  danger  that,  through  increased  virulence 
of  the  causative  germ  in  Brill's  disease,  serious  outbreaks  of  typhus 
may  occur  in  this  country,  should  proper  sanitary  measures  be 
neglected. 

The  cause  of  the  disease,  whether  bacterial  or  protozoal,  still 
remains  unknown. 

Our  knowledge  of  the  mode  of  transmission  in  typhus  fever 
suggests  the  necessary  prophylactic  measures,  namely,  prevention  of 
crowding,  house  sanitation,  personal  hygiene  and  destruction  of 
vermin. 

"  The  fact  should  be  kept  in  mind  that  the  louse  is  as  necessary 
for  the  spread  of  typhus  as  the  mosquito  is  for  malaria.  Where 
lice  are  present  typhus  is  possible ;  where  typhus  is  present  lice  will 
be  found."  (Bull.  10,  War  Dept,  1916.) 

Where  typhus  is  present,  daily  individual  inspection  for  vermin 
of  the  person  and  clothing  of  those  caring  for  the  patients,  or  other- 
wise exposed,  should  be  strictly  required. 

RELAPSING  FEVER  (RECURRENT  FEVER). 

An  infectious  disease  usually  occurring  in  epidemics,  characterized 
by  second  and  third  attacks  after  periods  of  remission.  Fcrmerly 
common  all  over  Europe  and  Asia,  but  there  have  been  few  epi- 
demics of  it  in  this  country,  where  it  never  showed  any  tendency  to 
spread.  It  is  still  endemic  in  the  Philippines  although  no  cases  have 
so  far  been  reported  among  our  troops.  Like  typhus,  it  is  a  disease 
of  poverty,  overcrowding  and  insanitary  conditions,  but  its  mortality 
is  small. 

The  specific  cause  is  a  spirillum  (Spirochaeta  recurrentis} . 

Xicolle  (in  Tunis)  has  shown  that  the  louse  becomes  infected  with 
it,  although  incapable  of  conveying  it  by  biting;  but  when  this 
insect  is  crushed  on  the  skin  of  its  host,  the  organism  is  released 
and  may  then  be  inoculated  by  scratching,  probably  the  usual  mode 
of  transmission.  This  infection  of  the  louse  may  also  be  inherited 
by  its  young. 


84  MILITARY    HYGIENE. 

The  relapsing  fever  of  South  Africa  (African  Tick  Fever)  is 
caused  by  another  and  larger  spirochete  (S.  duttoni}  which  is  trans- 
mitted by  a  tick  (Ornitkodoros  moubata). 


ROCKY  MOUNTAIN   SPOTTED   FEVER. 
(See  Ticks,  page  142.) 

As  defined  by  Rucker,*  an  acute  endemic  febrile  disease,  occurring 
chiefly  during  the  summer  months,  and  characterized  by  a  continuous 
moderately  high  fever,  severe  arthritic  and  muscular  pains,  and  a 
profuse  petechial  or  purpuric  eruption,  appearing  first  on  the  ankles, 
wrists  and  forehead,  but  rapidly  spreading  to  all  parts  of  the  body. 
The  incubation  period  is  usually  7  days. 

This  disease  has  been  reported  from  nearly  all  the  States  of  the 
northern  Rocky  Mountain  region,  but  is  especially  prevalent  in 
Montana  and  Idaho,  having  been  first  observed  and  still  existing  in 
its  most  virulent  form  in  the  Bitter  Root  Valley  of  Montana. 

The  mortality  varies  greatly,  according  to  localities,  indicating 
different  strains  of  the  infective  organism ;  thus  it  is  only  4  per  cent, 
in  Idaho,  while  often  exceeding  70  per  cent,  in  parts  of  Montana. 

Although  the  causal  germ  has  not  yet  been  discovered,  careful 
investigations  and  experiments  have  demonstrated  that  it  is  trans- 
mitted by  ticks,  but  chiefly  if  not  exclusively  by  the  wood-tick, 
Dermacent.or  andersoni  (D.  venustus} ,  which  attaches  itself  not 
only  to  man  but  to  various  other  mammalian  hosts,  infecting  them 
and,  in  turn,  being  infected  by  them.  It  is  evident  that  man  himself 
is  only  an  occasional  and  accidental  host  and  that,  when  sick  with 
this  fever,  ticks  have  seldom  any  chance  of  becoming  infected  by 
feeding  upon  him. 

From  the  experiments  of  Ricketts  and  others?  it  appears  that  the 
following  animals,  which  are  also  the  most  common  hosts  of  the 
tick  in  its  immature  stages,  are  susceptible  to  spotted  fever  through 
tick  bites  and  can  infect  other  ticks:  The  Columbian  ground  squirrel 
(Citellns  columbianus) ,  woodchuck  (Marmota  flaviventer},  side- 
striped  ground  squirrel  (C alias p enno philus} ,  yellow-bellied  chip- 
munk (Eiitamias}.  Whether  all  of  these,  or  more,  act  as  the  usual 
intermediary  hosts  for  the  causative  parasite,  thus  perpetuating  the 
disease,  has  not  been  determined.  The  Columbian  ground  squirrel, 

*  The  problem  of  the  Rocky  Mountain  spotted  fever,  by  W.  C.  Rucker, 
The  Military  Surgeon,  Dec.,  1911. 


INFECTIOUS    DISEASES    (CONTINUED).  85 

on  account  of  its  great  prevalence  in  the  infected  zone,  should  be 
regarded  as  the  most  dangerous. 

The  measures  of  prevention  suggest  themselves,  namely,  the 
destruction  of  ticks,  especially  of  adults  while  feeding  on  domestic 
animals,  and  personal  prophylaxis,  that  is  to  say,  the  wearing  of 
tick-proof  clothing  by  persons  entering  the  infested  zone,  and  the 
careful  daily  search  of  the  body. 

It  is  known  that  in  cattle  having  Texas  fever  (likewise  conveyed 
by  ticks)  the  causative  organism  may  remain  in  the  blood  for  years 
afterwards  and  that  ticks  feeding  upon  these  apparently  healthy 
animals  may  become  infected  and  transmit  the  disease.  Should  it 
be  likewise  with  persons  having  spotted  fever,  they  could  act  as  car- 
riers and  spread  the  infection  to  new  regions  should  suitable  ticks 
be  found  there  to  act  as  transmitters. 

PLAGUE. 

Plague  is  an  acute  infectious  disease  with  rapid  and  severe  course 
and  great  mortality.  Formerly  one  of  the  worst  scourges  of  the 
Old  World,  it  is  now  rarely  seen  in  epidemic  form,  but  remains  en- 
demic in  many  parts  of  America  and  Asia.  For  us  there  is  danger 
chiefly  from  South  and  Central  America,  Mexico  and  the  West 
Indies.  In  1912,  spots  of  infection  still  existed  all  along  the  west- 
ern and  eastern  coast  lines  of  South  America,  and  small  outbreaks 
were  reported  from  Porto  Rico  and  Cuba. 

In  this  country  it  first  manifested  itself  in  1900,  in  the  Chinese 
quarter  of  San  Francisco,  probably  imported  in  rats  from  Hawaii, 
and  was  not  eradicated  until  1904,  after  having  caused  the  death  of 
225  people.  It  reappeared  in  1907,  but  was  promptly  suppressed. 

Three  types  of  plague  are  recognized:  bubonic,  pneumonic  and 
septicemic.  In  the  bubonic  form,  which  is  the  most  common,  the 
infection  occurs  through  the  skin  and  is  first  localized  in  the  nearest 
lymphatic  glands,  which  swell  into  characteristic  buboes.  In  the 
pneumonic  form,  the  respiratory  tract  is  the  portal  of  entrance  and 
the  disease  takes  primarily  the  form  of  a  bronchopneumonia.  In 
the  septicemic,  there  is  a  general  blood  infection  from  the  beginning. 
The  last  two,  almost  invariably  fatal,  were  the  "  black  death  "  of  the 
Middle  Ages. 

Bubonic  plague  does  not  resist  a  temperature  higher  than  85°  F. 
or  lower  than  50°.  The  pneumonic  form  is  favored  by  cold,  being 
restricted  between  the  isothermal  lines  of  40°  and  50°  F. 


86  MILITARY    HYGIENE. 

The  causal  organism  is  the  Bacillus  pestis  of  Kitasato,  also  patho- 
genic for  nearly  all  animals.  It  is  a  short,  thick  bacillus  with  well- 
rounded  ends,  showing  characteristic  bipolar  staining  with  inter- 
mediate unstained  area.  It  is  frequently  found  in  the  urine  of 
patients,  but  very  rarely  in  the  feces.  Outside  of  the  animal  body 
it  may  retain  its  viability  for  months  in  a  dark  and  moist  environ- 
ment. In  pus  or  sputum  from  patients  it  may  live  one  to  two  weeks. 
Direct  sunlight  destroys  it  within  four  or  five  hours.  Steam  or  boil- 
ing water  is  effectual  in  a  few  minutes. 

In  pneumonic  plague  the  bacilli  ejected  in  coughing  are  soon  de- 
stroyed in  a  dry  atmosphere,  but  retain  their  vitality  much  longer 
in  humid  air.  As  pointed  out  by  Teague  and  Barber,  inasmuch  as 
the  atmospheric  relative  humidity  increases  with  the  degree  of  cold, 
it  follows  that  pneumonic  plague  is  more  commonly  found  and 
spreads  more  rapidly  in  cold  than  in  warm  countries.  The  only 
great  epidemic  of  this  infection  in  modern  times  occurred  in  Man- 
churia and  northern  China  during  the  winter  of  1910-1911. 

The  incubation  of  the  several  types  of  plague,  in  man,  is  from 
3  to  5  days,  while  the  duration  of  the  disease  seldom  exceeds  5  or  6 
days. 

Investigations  in  India  have  definitely  determined  that  bubonic 
plague  is  primarily  a  disease  of  rats,  and  that  the  flea  is  the  inter- 
mediary in  the  transmission  of  the  infection  from  rat  to  rat  and 
from  rat  to  man.  Two  species  of  rats,  found  nearly  in  all  parts  of 
the  world,  are  chiefly  concerned:  the  brown  or  Norway  rat,  also 
called  ship  or  sewer  rat  (Mus  decumanus),  by  far  the  most  common, 
and  the  black  or  house  rat  (Mus  rattus),  including  a  white-bellied 
variety  (Mus  Alexandrinus} .  An  epizootic  of  these  rats  always 
precedes  a  human  epidemic.  The  common  house  mouse  (Mus  mus- 
culus}  may  also  become  infected,  but  its  flea  (Ctenopsylla  musculi) 
hardly  ever  bites  man. 

The  several  species  of  fleas  concerned  (see  page  145)  live  indif- 
ferently on  the  brown  and  black  rats.  It  is  only  three  days  after 
the  death  of  these  hosts  that  they  seek  others  and  are  likely  to  bite 
man ;  therefore,  in  plague-stricken  countries  all  rats  should  be 
burned  up  within  48  hours  after  their  death  so  as  to  insure  the 
destruction  of  their  fleas.  The  two  most  dangerous,  because  readily 
attacking  man  when  hungry,  are  the  Xenopsylla  cheopsis  in  tropical 
and  subtropical  climates,  and  Cerato phyllus  fasciatus  in  cooler 


INFECTIOUS   DISEASES    (CONTINUED).  87 

regions.  The  dog,  cat  and  human  neas  seldom  play  any  part  in 
plague  transmission. 

The  plague  bacillus  is  found  in  the  digestive  tube  and  excrements 
of  the  flea  from  4  to  6  days  after  sucking  infected  blood,  and  there- 
after rapidly  disappears.  The  flea  infects  directly  while  biting, 
through  the  germs  adhering  to  the  mouth  parts,  or  oftener  indi- 
rectly through  its  habit  of  defecating  while  sucking  blood,  so  that 
germs  are  deposited  on  the  skin  close  to  the  bite;  if  the  latter  is 
rubbed  or  scratched,  the  germs  get  into  it  or  in  any  other  minute 
wound  of  the  skin 

Certain  authors,  notably  Le  Dantec,  hold  that,  since  rats  are 
promptly  destroyed  by  plague  there  must  be  other  animals  of  the 
same  or  allied  families,  like  marmots,  gophers  and  woodchucks, 
which  by  acquiring  a  certain  degree  of  immunity  can  act  as  perma- 
nent hosts  and  natural  reservoirs  for  the  plague  bacillus,  until 
opportunities  happen  for  rat  infection  and  a  human  outbreak.  Such 
a  permanent  host  was  discovered  in  California.  In  1907,  bubonic 
plague  having  reappeared  in  San  Francisco,  it  was  ascertained  that 
the  ground  squirrel  or  gopher  of  the  Pacific  Coast  States  (Citellus 
beecheyi},  a  rodent  quite  common  east  and  south  of  that  city,  was 
the  remote  cause  of  it,  many  of  these  animals  being  found  infected 
and  harboring  fleas  capable  of  transmitting  the  bacillus  to  rats  by 
which  it  was  conveyed  to  man.  They  are  the  more  dangerous  that 
they  acquire  a  relative  immunity  and  may  continue  indefinitely  as 
hosts.  Two  other  species  of  gophers  (C.  franklini  and  C.  tridecem- 
lineatus)  are  numerous  enough  east  of  the  Rocky  Mountains  to  be 
troublesome  in  cultivated  districts  and  a  source  of  danger  in  case 
of  plague  outbreak.  The  plague  bacillus  has  likewise  been  found 
in  the  wood  rat  (Neotoma  fuscipes)  of  the  Western,  Middle  and 
Southern  States. 

The  mode  of  transmission  of  the  pneumonic  plague  has  not  yet 
been  completely  cleared  up.  The  rat  and  flea  do  not  appear  to  be 
important  factors.  In  the  great  epidemic  which  prevailed  in  Man- 
churia in  1911,  only  the  pneumonic  type,  or  a  combination  of  this 
with  the  septicemic,  was  seen.  It  is  supposed  to  have  originated 
among  the  trappers  of  tarbagan  (Arctomys  bobac*)  in  handling  the 
skins ;  whether  through  direct  inoculation,  the  biting  of  fleas  or  the 

*  A  marmot  related  to  the  common  American  woodchuck  or  ground  hog 
( . /.  monax}  which  is  abundant  in  the  United  States  and  Canada. 


88  MILITARY    HYGIENE. 

« 

eating  of  the  flesh  has  not  been  ascertained.  A  severe  epizootic  had 
been  prevailing  among  these  animals  and  destroyed  many.  Neither 
rats  nor  other  animals  were  found  to  be  infected.  The  disease  was 
introduced  into  every  new  center  by  the  arrival  of  persons  actually 
suffering  from  plague  or  incubating  it.  It  was  shown  that  the 
human  host  and  rather  close  contact  were  the  two  most  prominent 
factors  in  the  spread  of  the  infection.  Transmission  by  clothing, 
merchandise  or  vermin  was  not  proved.  In  pneumonic  plague  the 
bacilli  are  not  usually  expelled  in  quiet  breathing,  but  are  abun- 
dantly disseminated  through  the  surrounding  air  by  coughing,  sneez- 
ing and  speaking.  The  sputum  is  loaded  with  them,  but  they  may 
be  ejected  in  large  numbers  even  when  there  is  no  visible  particle 
of  it.  From  the  studies  of  Strong,  Crowell  and  Teague,  it  would 
appear  that  plague  pneumonia  results  from  inhalation,  the  infection 
first  involving  the  bronchi  and  thence  extending  to  the  air-cells  and 
the  blood,  and  that  the  bacilli  are  not  primarily  absorbed  into  the 
general  circulation  and  secondarily  carried  to  the  lungs.  To  what 
extent  the  bacilli  may  be  absorbed  indirectly  through  soiled  hands 
or  contaminated  food  is  not  known. 

Diagnosis. —  The  material  for  smears  and  cultures  in  bubonic 
plague  should  be  drawn  from  a  bubo  with  a  syringe ;  in  the  pneu- 
monic type,  the  sputum  must  be  used.  Animal  inoculation,  espe- 
cially of  the  guinea  pig,  is  very  useful;  smearing  the  material  into 
the  intact,  shaven  skin  of  this  animal  with  a  glass  spatula  will  pro- 
duce the  infection.  In  pneumonic  plague  the  pulmonary  physical 
signs  are  obscure  in  the  early  stages  and  render  the  diagnosis 
difficult. 

Prophylaxis. —  Consists  essentially  in  good  sanitation,  the  de- 
struction of  intermediary  hosts,  especially  rats,  and  the  use  of  pro- 
tective vaccination.  Plague  thrives  in  filthy  places,  while  it  seldom 
attacks  people  living  in  clean  surroundings.  The  greatest  risk  al- 
ways threatens  bare-footed  and  bare-legged  people.  In  an  exposed 
community,  a  rigorous  quarantine  of  at  least  five  days  should  be 
maintained  against  all  suspected  ships  and  persons,  even  at  the  risk 
of  serious  interference  with  business,  for  when  plague  has  secured 
a  foothold  it  is  exceedingly  difficult  of  eradication.  Every  effort 
should  be  made  to  recognize  and  isolate  the  first  cases. 

Since  man,  in  bubonic  plague,  is  almost  always  infected  from 
rats,  the  first  preventive  measures  should  be  directed  against  them, 


INFECTIOUS    DISEASES    (CONTINUED).  89 

by  rat-proof  buildings  and  sewers,  cleaning  out  and  rendering  inac- 
cessible their  usual  haunts,  removing  their  food  supplies,  especially 
ill-kept  garbage  cans  and,  finally,  by  sulphur  or  hydrocyanic  acid 
fumigation  and  the  use  of  traps  and  poisons.  Of  the  latter,  phos- 
phorus, in  the  proportion  of  4  per  cent,  in  a  glucose  base  (IV.  C. 
Rucker),  is  among  the  best;  rats  like  it;  it  is  cheap  and  certain 
in  its  action.  The  rat  is  the  most  abundant,  useless,  destructive  and 
dangerous  of  the  predatory  animals  infesting  human  communities, 
and  a  continuous  warfare  should  be  waged  against  it  until  its  com- 
plete extinction.  Should  any  other  rodent  be  found  infected  and  a 
possible  reserve  source  of  bacilli  for  rats,  their  systematic  exter- 
mination should  also  be  undertaken.  For  the  destruction  of  fleas, 
see  page  146. 

In  pneumonic  plague,  attention  should  be  mostly  directed  to 
measures  of  isolation  and  disinfection,  the  destruction  of  rodents 
being  only  a  secondary  matter.  The  use  of  masks  or  respirators, 
by  the  attendants,  is  the  most  important  measure  of  direct  presonal 
phophylaxis.  The  mask  should  protect  the  mouth,  nose  and  eyes,  as 
well  as  any  abrasion  of  the  face  and  neck. 

Patients  should  be  promptly  removed  to  a  special  hospital,  and 
their  houses,  with  all  contents,  thoroughly  disinfected,  special  atten- 
tion being  paid  to  rats,  mice,  fleas  and  flies. 

Haffkine's  method  of  prophylaxis  by  the  inoculation  of  cultures 
of  the  bacillus  killed  at  a  temperature  of  65°  C.,  reduces  the  mor- 
tality, it  is  claimed,  to  about  one-fourth.  The  immunity  thus  con- 
ferred only  lasts  a  few  months.  Yersin's  serum  from  immunized 
horses  has  also  prophylactic  value. 


CHAPTER  VII. 
INFECTIOUS  DISEASES  (CONTINUED). 

EPIDEMIC   CEREBROSPINAL  MENINGITIS. 

An  acute  infectious  disease  with  special  lesions  of  the  meninges  of 
the  brain  and  cord.  Common  in  Europe  and  America,  but  chiefly 
at  home  in  this  country,  where  it  causes  a  notable  proportion  of  the 
yearly  mortality  in  crowded  and  unsanitary  districts.  Among  our 
troops,  in  the  United  States,  small  outbreaks  occur  every  year,  with 
a  mortality  of  over  50  per  cent.  During  the  5  years  1907-1911, 
the  number  of  admissions  was  65,  with  49  deaths.  During  1915, 
23  cases  were  reported,  with  9  deaths.  Very  few  cases  occur  in 
our  colonies. 

The  accepted  cause,  in  the  epidemic  and  sporadic  forms,  is  a 
double  coccus,  Diploc'occus  intracellularis  meningitidis  of  Weichsel- 
baum,  or  Meningococcus,  found  not  only  in  the  involved  tissues,  but 
also  in  the  secretions  from  the  mouth,  nose  and  pharynx.  It  pos- 
sesses a  low  degree  of  vitality  and  quickly  perishes  when  removed 
from  the  body  and  exposed  to  air  and  sunlight,  or  to  heat  and  cold, 
so  that  it  is  impossible  to  demonstrate  it  in  air,  dust  or  fomites.  It 
is  most  probable  that  transmission  takes  place  directly,  from  person 
to  person,  by  inhalation  of  droplets  ejected  by  patients  or  carriers  in 
coughing,  sneezing  or  speaking.  The  mode  of  access  to  the  cranial 
cavity  is  a  matter  of  some  doubt,  probably  by  absorption  into  the 
circulation  through  the  mucosa  of  the  nose  and  pharynx. 

It  is  also  quite  likely  that  infection  may  result  from  the  use  of 
common  eating  or  drinking  utensils,  contamination  of  food  by  soiled 
fingers,  etc. 

Very  few  persons  of  those  who  acquire  the  organism  are  suscep- 
tible to  it  and  become  infected,  but  they  may  transmit  it  to  suscep- 
tible persons,  so  that  the  disease  is  mostly  disseminated  by  carriers. 
The  germs,  in  the  naso-pharyngeal  cavities  of  carriers,  seldom  last 
longer  than  30  days,  but  may  remain  alive  several  months;  some 
persons  carry  them  permanently. 

Whenever  the  diagnosis  is  doubtful  it  can  be  cleared  up  by  a 
lumbar  puncture  and  the  examination  of  the  spinal  fluid  for  the 

90 


INFECTIOUS   DISEASES    (CONTINUED).  91 

meningococcus.  But  as  this  is  not  always  easily  differentiated,  re- 
sort may  be  had  to  the  high  agglutinating  value  of  immune-horse 
serum. 

The  prophylaxis  consists  in  the  isolation  of  patients,  with  suffi- 
cient air  space  and  ventilation,  and  all  other  measures  tending  to 
prevent  contamination  with  the  oral  and  nasal  secretions.  The 
attendants  should  wear  gowns  and,  besides,  a  cap  and  a  mask  of 
gauze. 

Wherever  this  disease  prevails,  carriers  are  so  many  that  it  is 
generally  impracticable  to  quarantine  them,  but,  as  far  as  possible, 
they  should  be  detected  and  isolated,  or  at  least  kept  under  obser- 
vation and  carefully  instructed  as  to  what  to  do  and  what  to  avoid. 

The  treatment  consists  chiefly  in  the  injection  of  the  antimeningitic 
serum  of  Flexner  and  Jobling  in  the  spinal  canal  after  a  certain 
quantity  of  spinal  fluid  has  been  withdrawn.  Generally  from  20 
to  30  c.  c.  are  injected  daily  until  3  or  4  injections  are  made.  This 
serum  has  reduced  the  mortality  from  73  to  25  per  cent,  in  adults, 
and  to  less  than  20  per  cent,  in  children. 

Excellent  results  have  also  been  reported  from  vaccination  with 
meningo-bacterin,  the  reaction  being  very  much  like  that  observed 
after  the  use  of  typhoid  vaccin. 

DIPHTHERIA. 

A  disease  of  minor  importance  in  the  Army.  During  the  3  years 
1908-1910,  156  cases  were  reported,  with  7  deaths,  corresponding  to 
yearly  rates  of  0.75  per  thousand  of  strength  for  admission  and 
0.03  for  deaths.  Diphtheria  is  rare  in  tropical  countries ;  during 
the  decade  1900-1910,  only  82  cases  were  reported  in  the  population 
of  Manila.  Since  the  introduction  of  a  specific  antitoxin  in  its 
treatment,  the  mortality  has  fallen  in  New  York  City  from  14  per 
10,000  of  population  (before  1895)  to  2.17  in  1911. 

Diphtheria  is  caused  by  the  bacillus  of  Klebs  and  LoefHer,  which 
induces  a  specific  reaction  in  mucous  membranes,  especially  of  the 
throat,  larynx  and  nose,  resulting  in  the  formation  of  pseudomem- 
branes.  The  symptoms  depend  partly  upon  the  mechanical  disturb- 
ances and  local  inflammation  caused  by  these  membranes,  but  chiefly 
upon  the  systemic  poisoning  from  the  toxin  secreted  by  the  bacilli. 

Active  and  virulent  bacilli  may  linger  for  weeks  in  the  mouths, 
throats  and  noses  of  persons  who  have  entirely  recovered  from  the 


92  MILITARY    HYGIENE. 

disease.  It  has  also  been  found-  that  mild  colds  and  sore  throats 
may  be  due  to  the  diphtheria  germ,  although  the  subjects  are  not 
sick  and  present  no  characteristic  symptoms.  Thus  carriers  are  not 
uncommon  during  outbreaks  of  this  disease. 

The  infection  is  directly  transmitted  by  the  minute  particles  of 
pseudomembranes  ejected  in  coughing  and  sneezing.  Therefore  no 
patient  should  be  released  from  isolation  until  the  absence  of  bacilli 
from  the  throat  and  nose  has  been  demonstrated  by  2  or  3  succes- 
sive negative  cultures  at  48-hour  intervals. 

With  the  exception  of  the  clothing  and  bedding,  no  terminal  dis- 
infection is  now  deemed  necessary. 

SMALLPOX    (VARIOLA). 

Smallpox,  although  the  most  preventable  of  infectious  diseases, 
by  vaccination,  continues  to  be  widespread  in  the  United  States. 
The  number  of  cases  reported  from  27  States,  for  1910,  was  30,352, 
with  415  deaths.  The  very  low  case  mortality  (1.4  per  cent.) 
shows  the  type  of  the  infection  to  be  very  mild,  as  it  had  been  during 
the  previous  12  years,  probably  an  indirect  result  of  generalized 
vaccination.  During  the  3  years  1908-1910,  32  cases  occurred  in 
the  U.  S.  Army,  with  i  death,  all  sporadic  cases  contracted  outside 
of  military  reservations.  During  1915,  the  same  widespread  preva- 
lence continued  in  the  United  States,  but  among  our  troops  only  3 
cases  occurred  (all  in  United  States),  without  death. 

The  period  of  incubation  in  smallpox  is  about  12  days,  and  that 
of  invasion  3  or  4  days.  It  is  a  highly  contagious  disease  from  the 
earliest  symptoms  until  the  completion  of  desquamation,  about  six 
weeks.  Its  causative  organism  or  virus  has  not  yet  been  deter- 
mined ;  it  exists  chiefly  in  the  contents  of  the  pustules,  as  well  as  in 
their  crusts  and  scales.  It  is  certain  that  this  disease  is  transmitted 
with  extreme  ease,  being  one  of  the  so-called  air-borne  infections. 
Most  probable,  however,  as  in  measles,  it  is  only  transmitted  by 
contact,  direct  or  indirect. 

Vaccination,  properly  done,  confers  absolute  immunity  against 
smallpox  for  a  number  of  years.  Calf  lymph  is  almost  exclusively 
employed  at  the  present  day.  There  is  strong  evidence,  however, 
that  the  matter  obtained  directly  from  the  pustules  of  variolous 
patients  confers  more  complete  and  lasting  immunity,  and  is  there- 
fore preferable  whenever  the  subject  furnishing  it  is  known  to  be 


INFECTIOUS   DISEASES    (CONTINUED).  93 

free  from  syphilis  and  other  inoculable  infections.  The  immunity 
given  by  calf  lymph  lasts  8  or  10  years  in  youth,  but  much  longer 
in  the  adult  period  of  life.  It  is  necessary  that  a  person  vaccinated 
in  infancy  be  revaccinated  when  n  or  12,  and  again  when  about  22 
or  23  years  old.  Many  careful  observers  contend  that  an  adult 
with  good  scars  showing  two  successful  vaccinations  should  be  con- 
sidered immune  for  life  and  excused  from  further  operation.  As 
the  degree  of  protection  greatly  depends  upon  the  amount  of  virus 
inserted,  not  less  than  three  spots,  an  inch  apart,  and  each  about 
half  an  inch  in  diameter,  should  be  scarified  and  inoculated.  The 
scar  left  by  vaccination  to  be  perfect,  that  is  to  say,  an  evidence  of 
successful  operation,  should  be  uniformly  pitted  and  free  from 
smooth  cicatrix  tissue,  the  result  of  sloughing. 

It  is  doubtful  whether  there  are  any  persons,  not  having  had 
smallpox,  immune  to  primary  vaccination.  Failure,  as  a  rule,  is 
the  result  of  inert  lymph,  careless  method  or  removal  of  virus  by 
rubbing  or  washing.  It  is  therefore  expedient  to  vaccinate  scarless 
recruits,  having  no  history  of  smallpox,  repeatedly  until  success 
follows  or  absolute  immunity  is  satisfactorily  established. 

At  the  first  enlistment  all  recruits  must  be  vaccinated,  except  those 
who  are  pock-marked,  and  those  who  have  good  scar  evidence  of 
two  successful  vaccinations,  the  last  not  to  be  more  than  six  years 
old,  or  of  one  successful  vaccination  performed  within  the  three 
previous  years.  At  every  reenlistment  a  soldier  should  be  revac- 
cinated who  does  not  bear  the  evidence  of  two  successful  vaccina- 
tions, or  of  one  successful  vaccination  performed  within  the  three 
previous  years.  Before  scarifying  the  skin,  it  should  be  carefully 
disinfected  and  the  disinfecting  material  washed  off  with  sterile 
water;  after  the  operation  a  protecting  shield  or  dressing  should 
be  applied. 

The  usual  measures  of  prophylaxis  where  smallpox  breaks  out 
consist  in  the  strict  isolation  of  patients  and  the  thorough  disinfec- 
tion of  their  bedding  and  clothing.  Their  rooms  may  also  be  fumi- 
gated, although  this  is  of  doubtful  utility.  All  unprotected  persons 
who  have  been  or  may  be  exposed  to  the  contagion  should  be 
promptly  vaccinated. 

Varioloid  is  a  mild  form  of  smallpox  occurring  in  persons  who 
have  been  imperfectly  vaccinated  or  whose  immunity  has  been  partly 
lost.  It  is  dangerous  only  in  its  capability  of  transmitting  true 
smallpox  to  unprotected  persons. 


94  MILITARY    HYGIENE. 

Chicken-pox  (Varicella),  a  mild,  harmless  eruptive  fever,  lasting 
but  a  few  days,  is  entirely  distinct  from  smallpox  and  therefore 
does  not  protect  against  it. 

SCARLET   FEVER    (SCARLATINA). 

Scarlet  fever  is  of  secondary  importance  in  the  Army.  During 
the  three  years  1909-1911,  only  43  cases,  with  one  death,  were  re- 
ported. It  is  not  as  highly  infectious  as  measles,  nor  is  there  the 
same  susceptibility  to  it  on  the  part  of  soldiers,  but,  on  the  other 
hand,  the  vitality  of  its  causative  agent  or  virus  is  very  remarkable, 
often  persisting  for  several  months.  The  nature  of  this  specific 
cause  is  not  known.  The  streptococci  nearly  always  present  in  the 
throat  of  patients  are  only  a  secondary  growth,  responsible  for  some 
of  the  complications  of  the  disease.  Certain  inclusion  bodies  are 
always  found  in  the  polymorphonuclear  leucocytes  of  the  blood 
during  the  first  week,  but  they  are  also  secondary  invaders,  likewise 
present  in  diphtheria  and  other  infections ;  their  only  value  is  in 
differentiating  scarlet  fever  from  measles  and  rotheln. 

Scarlet  fever  is  transmitted  by  the  secretions  from  the  nose  and 
mouth,  and  probably  by  the  desquamating  skin  and  the  urine.  There 
is  danger  of  contagion  from  the  first  appearance  of  the  symptoms 
until  the  cessation  of  discharges  and  completion  of  desquamation. 

On  account  of  the  peculiar  resistance  of  the  virus,  careful  disin- 
fection is  more  essential  than  in  measles  and  most  other  infectious 
diseases.  It  should  include  not  only  all  fomites,  but  also  the 
patient's  room.  It  is  advisable  to  segregate  cases  with  secondary 
infections  from  simple  uncomplicated  cases. 

MEASLES   (RUBEOLA  OR  MORBILLI). 

Measles  is  a  highly  contagious  disease  from  which  few  children, 
in  cities,  find  it  possible  to  escape.  Although  usually  a  mild  form 
of  infection,  with  low  mortality,  its  prevalence  is  such  that,  accord- 
ing to  the  official  census  of  1910,  measles  stands  next  to  diphtheria, 
of  all  infectious  diseases,  as  a  cause  of  death  among  children. 
In  the  Army  it  is  responsible  for  more  deaths  than  all  the  other 
eruptive  fevers  together.  For  the  three  years  1908-1910,  the  yearly 
ratio  of  admissions  per  thousand  of  strength  was  9.62,  and  of  deaths 
0.24.  During  the  year  1910,  317  cases  occurred  in  the  Army  with 
only  one  death,  but  in  1911,  a  severe  epidemic  prevailed  at  Columbus 


INFECTIOUS   DISEASES    (CONTINUED).  95 

Barracks,  O.,  with  126  cases  and  16  deaths,  the  principal  complica- 
tions being  broncho-pneumonia,  pleurisy  and  otitis  media. 

During  1915,  555  cases  occurred  in  the  Army  (chiefly  at  the 
recruit  depots)  with  20  deaths  and  8  discharges,  being  the  disease 
causing  the  greatest  number  of  deaths,  next  to  pneumonia.  In 
camps,  cases  of  measles  should  always  be  expected,  watched  for  and 
promptly  isolated. 

The  incubation  period  is  about  12  days,  and  that  of  invasion  3 
or  4  days.  The  causative  agent  is  unknown,  but  Herkoen  (1905) 
first  demonstrated  its  presence  in  the  blood.  Goldberger  and  An- 
derson of  the  Public  Health  Service,  by  experimenting  with  mon- 
keys, have  lately  shown  that  it  is  present  in  the  blood  at  least  a  few 
hours  before  the  eruption  appears  and  for  about  36  hours  after. 
They  have  also  demonstrated  that  it  is  contained  in  the  nasal  and 
buccal  secretions  during  the  first  48  hours  of  the  eruptive  period, 
and  that  it  is  absent  from  the  desquamating  epidermis.  From  these 
discoveries  several  inferences  may  be  drawn,  namely :  that  measles 
is  not  an  air-borne  disease  as  generally  understood;  that  most,  if 
not  all,  cases  are  contracted  in  the  early  part  of  the  eruptive  stage, 
often  before  a  diagnosis  is  made  and  the  patient  isolated ;  that  its 
virus  is  short-lived;  and  that  the  quarantine  after  desquamation, 
usually  imposed  on  patients,  may  be  considerably  reduced. 

No  evidence  exists  that  there  are  carriers  of  measles  or  that 
healthy  persons  have  anything  to  do  with  its  propagation ;  the 
patient  alone  is  the  source  of  danger.  It  is  therefore  an  unnecessary 
hardship,  when  a  case  occurs  in  a  family,  to  quarantine  the  entire 
household. 

The  measures  to  prevent  the  spread  of  this  disease  consist  chiefly 
in  an  early  diagnosis  and  the  effective  isolation  of  patients.  It  is 
desirable,  when  possible,  to  separate  cases  with  secondary  infections 
from  simple  uncomplicated  cases.  In  an  outbreak  at  a  post  or 
camp,  every  man  who  has  not  had  the  disease  should  be  required  to 
report  daily  to  a  medical  officer  to  be  examined,  especially  for  Kop- 
lick's  spots,  rise  of  temperature,  coriza  and  cough.  The  discharges 
from  the  eyes,  nose  and  mouth  should  be  received  on  pieces  of  cloth 
and  burned  or  otherwise  disinfected.  The  hands  of  the  nurses 
must  be  carefully  and  frequently  washed.  It  is  best  to  disinfect  the 
patient's  clothing  and  bedding,  but  unnecessary  to  disinfect  his  room. 

Rotheln  or  German  measles  (rubella)  is  a  contagious  eruptive  dis- 


96  MILITARY    HYGIENE. 

order  bearing  some  resemblance  to  measles  and  scarlet  fever,  but 
showing  its  distinct  specific  character  in  the  fact  that  it  protects 
from  neither  of  these  diseases.  It  is  very  mild,  seldom  attended 
with  any  febrile  movement  and  always  ending  in  perfect  recovery. 

MUMPS    (PAROTITIS  EPIDEMICA). 

A  very  infectious  disease,  of  little  gravity  and  no  mortality,  but 
sufficiently  serious  to  keep  soldiers,  when  attacked  with  it,  off  duty 
for  several  weeks.  In  the  Army  it  is  nearly  as  common  as  measles, 
the  yearly  ratio  of  admissions  per  thousand  of  strength,  for  the 
period  1908-1910,  being  8.52. 

The  causative  virus  (not  yet  determined)  is  contained  in  the  dis- 
charges from  the  throat  and  may  transmit  the  infection  from  the 
earliest  symptoms  until  about  10  days  after  the  swelling  disappears, 
a  period  of  about  three  weeks. 

The  parotitis  may  be  accompanied  or  followed  by  orchitis  which, 
occasionally,  proves  a  tedious  complication. 

Petrilli,  of  Rome,  believes  that  mumps  generally  begins  as  a 
pharyngitis  and  that  the  infection  can  be  arrested  before  it  reaches 
and  invades  the  duct  of  the  parotid  gland,  by  the  application  of 
iodin. 

INFLUENZA    (GRIPPE). 

A  very  infective  disease  characterized  by  the  rapidity  of  its  spread 
over  vast  areas.  Its  causative  bacillus  is  an  extremely  small  organ- 
ism, very  sensitive  to  heat,  desiccation  and  disinfectants,  dying  in 
dry  sputum  within  one  or  two  hours.  During  epidemics,  it  is  found 
with  much  regularity  in  the  nasal  passages  and  bronchial  secretions 
of  patients,  most  frequently  causing  a  form  of  broncho-pneumonia; 
it  may  also  be  found  in  various  parts  of  the  nervous  system  causing 
corresponding  morbid  symptoms ;  nor  is  it  rare  in  the  secretions  of 
normal  and  healthy  individuals.  In  local  outbreaks  or  sporadic 
cases  the  agency  of  this  bacillus  is  uncertain  and  puzzling,  being 
generally  associated  with  other  organisms  so  that  the  course  of  the 
disease  is  irregular  and  atypical.  It  is  also  a  common  invader  of 
the  air-passages  in  other  diseases,  notably  whooping-cough,  bron- 
chitis and  tuberculosis. 

The  spread  of  influenza  is  particularly  favored  by  overcrowding 
and  defective  ventilation.  Patients  should  be  isolated,  so  far  as 
possible.  The  secretions  from  the  mouth  and  nose  being  the  means 
of  transmitting  the  disease  should  be  carefully  disinfected. 


CHAPTER  VIII. 
INFECTIOUS  DISEASES  (CONTINUED). 

TETANUS  OB  LOCKJAW. 

Tetanus  is  usually,  if  not  always,  of  traumatic  origin,  and  results 
from  an  infection  of  the  nervous  system,  generally  through  a 
neglected  punctured,  lacerated  or  gunshot  wound  of  the  extremities. 

The  Bacillus  tetani  is  the  most  important  organism  of  the 
anaerobic  spore  bearers ;  the  spore,  being  strictly  terminal,  gives  it 
a  characteristic  drumstick  appearance.  It  occurs  commonly  in  the 
superficial  layers  of  the  soil,  especially  in  cultivated  and  manured 
fields.  The  spores,  if  protected  from  sunlight  and  other  deleterious 
influences,  may  remain  viable  for  many  years.  It  is  probable  that, 
in  many  cases  of  wound  infection,  they  fall  a  prey  to  phagocytosis 
before  toxin  is  formed,  and  are  therefore  harmless.  This  may  ex- 
plain the  comparative  rarity  of  tetanus,  although  its  germs  are 
widely  distributed  in  nature. 

The  tetanus  bacillus  seems  to  grow  better  in  symbiosis  with 
aerobes;  hence  a  dirty,  suppurating  wound,  contaminated  with 
various  cocci,  offers  the  most  favorable  soil.  According  to  A.  P.  C. 
Ashhurst,  tetanus  will  never  result  from  any  wound  properly  treated 
from  the  beginning. 

The  pathogenicity  of  the  bacillus  depends  entirely  upon  the 
soluble  toxin  which  it  produces  and  which  is  one  of  the  most  power- 
ful poisons  known.  It  is  conducted  to  the  nerve  centers  along  the 
path  of  the  motor  nerves,  but  is  also  absorbed  by  the  lymph  ves- 
sels and  conveyed  into  the  general  circulation.  The  period  of  incu- 
bation, that  is  to  say,  the  time  required  for  the  toxin  to  reach  the 
nervous  centers,  ranges  from  I  to  4  weeks  and  averages  about  15 
days. 

An  antitoxin,  obtained  from  highly  immunized  horses,  in  the  same 
manner  as  diphtheria  antitoxin,  is  successfully  used  as  a  prophy- 
lactic as  well  as  in  the  treatment  of  the  disease. 

Tetanus  is  more  common  in  warm  than  in  cold  and  temperate 
countries,  and  in  some  tropical  regions  may  result  from  a  large 
proportion  of  all  wounds  fouled  by  earth  or  dirt.  During  the 
Russo-Japanese  War,  in  Manchuria,  a  few  cases  of  it  were  always 

97 


98  MILITARY    HYGIENE. 

under  treatment  in  the  Russian  hospitals.  In  the  U.  S.  Army, 
during  the  period  of  n  years  1898-1908,  only  17  cases  were  re- 
ported, with  12  deaths.  Since  then  the  number  of  cases  has  been 
steadily  decreasing. 

In  the  present  European  War,  owing  to  the  great  soil  pollution, 
the  severity  of  the  wounds  and  the  almost  insuperable  difficulty  of 
transporting  patients  to  field  or  base  hospitals  for  suitable  treatment 
within  a  day  or  two.,  tetanus  was  at  first  alarmingly  frequent  in 
shrapnel  and  other  artillery  wounds.  But  as  the  prophylactic  value 
of  anti-tetanic  serum  became  better  understood  it  was  administered 
subcutaneously  in  all  cases  of  septic  wounds,  and  a  great  improve- 
ment at  once  took  place.  The  primary  injection,  consisting  of  500 
units,  is  given  at  the  dressing  station  or  field  hospital  as  soon  as  the 
wounded  soldier  reaches  it.  It  should  be  inserted  near  the  principal 
nerve  supplying  the  region  of  the  wound.  A  second  injection  of 
the  same  strength  is  generally  given  7  days  later.  A  third  and  a 
fourth  may  be  indicated.  Tetanus  is  now  rarely  seen  in  patients 
who .  have  received,  betimes,  a  sufficiency  of  serum  and  whose 
wounds  are  freely  incised  and  disinfected. 

In  the  curative  treatment  of  tetanus  the  element  of  time  is  all- 
important,  and  active  intervention  should  begin  as  soon  as  the  diag- 
nosis is  made.  The  first  manifestations  of  the  infection  are  rigid- 
ity, twitchings  or  local  increased  reflex  to  gentle  tapping  in  the 
muscles  round  the  wound.  It  is  therefore  desirable  that  these  mus- 
cles be  examined  whenever  the  dressings  are  removed.  An  early 
bacteriological  examination  of  the  secretions  from  any  suspicious 
wound  is  also  important.  Clinical  experience  has  shown  that  the 
best  results  are  obtained  by  injections  into  the  spinal  canal ;  as  only 
20  c.  c.  can  thus  be  injected,  the  serum  should  be  of  high  potency. 
At  the  same  time,  5,000  to  10,000  units  are  injected  intra-muscularly 
around  the  wound.  Intraneural  and  intravenous  injections  have 
also  been  found  useful. 

The  symptomatic  treatment  consists  chiefly  in  the  exhibition  of 
sedative  drugs. 

The  local  treatment  recommended  by  Ashhurst  is  to  incise  the 
wound  freely,  clean  it  carefully  and  then  swab  it  with  a  3  per  cent, 
alcoholic  solution  of  iodin.  This  solution  is  also  painted  on  the  sur- 
rounding skin.  The  wound  is  daily  irrigated  with  hydrogen  peroxid 
and  dressed  with  gauze  soaked  in  the  iodin  solution. 


INFECTIOUS   DISEASES    (CONTINUED).  99 

The  Carrel  treatment  with  Dakin's  solution  is  now  generally  pre- 
ferred. 

BABIES. 
(Hydrophobia,  Lyssa.) 

Primarily  a  disease  of  dogs,  cats,  wolves  and  skunks,  but  com- 
municable to  man  through  the  saliva  of  the  rabid  animal  gaining 
entrance  to  the  wounds  made  in  biting  and  scratching.  According 
to  the  investigations  of  the  Public  Health  Service,  there  were  in 
the  United  States,  in  1911,  1,381  reported  cases  of  rabies,  with  98 
deaths.  For  1914  the  Census  Bureau  reports  65  deaths  in  the  regis- 
tration area  of  the  United  States.  In  1915  the  dissemination  of 
the  disease  among  coyotes  and  sheep  dogs  in  California  and  other 
Pacific  States  had  resulted  in  heavy  losses  to  stock  owners  from 
bites  inflicted  upon  cattle  and  sheep.  In  spite  of  this,  little  if  any 
increase  in  the  incidence  of  the  disease  has  occurred  in  man. 

The  time  of  incubation  in  man  varies  from  14  to  90  days,  and  in 
the  dog  and  cat  from  14  to  60  days.  This  slow  and  irregular  incu- 
bation is  explained  by  the  fact  that  the  virus  is  conveyed  to  the 
central  nervous  system  chiefly  by  the  nerve  trunks  and  not  by  the 
blood-vessels ;  therefore  it  is  shortest  and  the  disease  is  most  severe 
when  the  wounds  are  about  the  head,  neck  and  upper  extremities. 

Rabies  in  man  begins  with  headache  and  nervous  depression,  fol- 
lowed by  difficulty  in  swallowing,  especially  water,  spasms  of  the 
respiratory  muscles,  perhaps  maniacal  attacks  and,  finally,  paralysis 
and  death. 

The  causative  agent  is  not  known.  Peculiar  round  bodies, 
"  Negri  bodies,"  always  form  in  the  cells  of  the  central  nervous 
system  of  rabid  dogs,  especially  in  the  cornu  ammonis,  and  their 
determination  is  an  extremely  important  method  of  diagnosis. 
They  are  considered  protozoa  by  some  and  the  parasitic  cause  of 
rabies,  but  the  existing  evidence  does  not  warrant  such  assertion. 
Most  pathologists  believe  them  to  be  simply  products  of  cellular 
reactions. 

The  prophylactic  treatment  (Pasteur's)  applied  to  persons  bitten 
by  rabid  animals  and  suspected  of  being  infected,  consists  in  an 
active  immunization  with  an  emulsion  of  the  spinal  cord  of  a  rabid 
rabbit,  in  doses  of  increasing  virulence.  By  this  treatment,  which 
lasts  about  20  days,  the  mortality  is  reduced  to  one  per  cent.  It 
can  be  carried  out  at  the  home  of  the  patient,  or  at  any  post  hospital. 


IOO  MILITARY    HYGIENE. 

by  the  use  of  glycerinated  virus  which  is  sufficiently  stable  for  ship- 
ment by  mail  or  express.  It  is  estimated  that  16  per  cent,  of  per- 
sons bitten  develop  rabies  (if  untreated)  and  that  all  die. 

As  soon  as  possible  after  the  bite,  the  wound  should  be  cauterized 
with  nitric  acid  (followed  by  salt  solution)  or  phenol  (followed  by 
alcohol).  Better  still,  according  to  J.  G.  Gumming,  is  a  5  per  cent, 
formalin  solution  applied  for  12  hours. 

In  diagnosing  rabies  in  dogs,  it  is  best  to  keep  the  animal  alive, 
securely  tied,  so  that  the  symptoms  may  be  noted.  A  rabid  dog  is 
restless  and  irritable,  easily  startled  and  scared ;  it  has  difficulty  in 
chewing  and  swallowing,  but  not  in  drinking;  there  is  a  change  in 
its  bark  or  a  loss  of  it;  later  it  may  snap  at  imaginary  things  and 
perhaps  develop  a  furious  stage.  Paralysis  is  always  present  and 
begins  early,  at  first  shown  by  difficulty  in  walking  (from  paralysis 
of  left  hind  leg)  and  drooping  of  the  lower  jaw,  and  finally  causing 
death  in  from  4  to  7  days  after  the  appearance  of  the  first  symptoms. 

In  case  a  rabid  dog  has  been  killed,  it  is  generally  possible  to 
make  a  diagnosis  by  the  demonstration  of  the  Negri  bodies,  or  the 
inoculation  of  a  rabbit  (into  the  brain  substance  or  under  the  dura) 
with  a  salt-solution  emulsion  of  the  medulla  of  the  dead  dog. 

ANTHRAX. 

Usually  an  infectious  disease  of  herbivora,  especially  cattle  and 
sheep,  but  occasionally  occurring  in  horses,  hogs  and  goats,  as  well 
as  in  man.  Its  causal  organism  (Bacillus  anthracis)  is  an  aerobic, 
spore-bearing,  straight  rod  with  square-cut  ends,  often  forming 
chains.  The  large  oval  spore  is  located  in  the  middle  of  the  bacillus. 
Because  of  this  spore-forming  property  the  anthrax  bacillus  is  ex- 
tremely resistant  to  chemical  and  physical  agents ;  it  may  be  kept  in 
a  dry  state  for  many  years  without  losing  its  viability. 

Infection  in  animals  takes  place  mostly  by  way  of  the  ali- 
mentary canal,  also  cutaneously  through  abrasions  or  punctures 
about  the  mouth,  and  is  quickly  fatal.  In  man  the  disease  is  usually 
acquired  by  inoculation,  but  may  also  be  contracted  by  inhalation  and 
more  rarely,  by  deglutition.  Inoculation  occurs  through  small  cuts 
or  scratches  on  hands  or  arms  of  men  who  handle  live-stock, 
of  butchers  and  tanners,  or  on  the  neck,  face  and  back  of  men 
wearing  infected  sheepskin  coats  or  hats.  The  primary  lesion 
("  malignant  pustule  ")  resembles  at  first  an  ordinary  furuncle,  but 


INFECTIOUS   DISEASES    (CONTINUED).  IOI 

soon  its  center  is  filled  with  sero-sanguineous  and  purulent  fluid, 
while  it  becomes  surrounded  with  a  ring  of  vesicles  and  an  angry, 
red,  edematous  areola.  Generally,  especially  if  prompt  excision  is 
practised,  the  patient  recovers.  The  pulmonary  infection  known  as 
"  wool-sorter's  disease,"  and  which  manifests  itself  as  .a  violent, 
irregular  pneumonia,  occurs  in  persons  handling  infected  wool,  hair 
or  hides,  by  the  inhalation  of  spores  which,  from  the  mucosa  of  the 
upper  respiratory  tract  where  they  are  arrested,  are  carried  to  the 
lungs  and  pleura  by  the  lymphatics. 

Spores  do  not  form  in  the  body  of  an  animal  dead  from  anthrax 
until  free  access  of  air  is  made  possible  by  a  post-mortem  examina- 
tion or  natural  disintegration.  For  this  reason,  it  is  better  to  bury 
such  animal  without  opening  the  body,  and  to  make  the  diagnosis  by 
cutting  off  an  ear. 

The  general  prophylaxis  consists  chiefly  in  the  killing  and  burial 
or  cremation  of  infected  animals,  and  in  disinfection  with  corrosive 
sublimate.  Pasteur  has  shown  that  earthworms  will  bring  anthrax 
spores  to  the  surface  from  a  depth  of  at  least  five  feet;  hence  the 
necessity  of  cremation,  or  of  deep  burial  after  disinfection. 

Anthrax  should  not  be  confounded  with  Symptomatic  Anthrax 
or  "  blackleg,"  which  is  caused  by  an  entirely  different  organism 
and  has  never  been  observed  in  man. 

GLANDERS. 

An  infectious  disease  chiefly  prevalent  among  horses,  mules  and 
asses,  but  occasionally  transmitted  to  other  domestic  animals  and 
to  man.  The  causal  organism,  Bacillus  mallei,  is  a  small,  non- 
motile  rod  with  rounded  ends.  Heating  to  75°  C.  kills  it  within  an 
hour,  and  is  easily  destroyed  by  the  ordinary  chemical  disinfectants. 
In  water  it  may  remain  alive  several  months. 

Infection  takes  place  through  the  broken  skin  or  mucosa,  and  not 
infrequently  through  the  digestive  tract.  In  horses,  glanders  occurs 
in  an  acute  or  chronic  form ;  the  former  is  usually  limited  to  the 
nasal  mucosa  and  upper  respiratory  tract  from  which  an  abundant 
sera-purulent  secretion  is  discharged ;  the  latter,  usually  known  as 
"  farcy,"  is  characterized  by  multiple  swellings  of  the  skin  and 
general  lymphatic  enlargement,  some  of  the  swellings  showing  a 
tendency  to  break  down  and  ulcerate. 

Glanders  in  man  is  usually  contracted  from  contact  with  diseased 


IO2  MILITARY    HYGIENE. 

horses,  and  is  almost  always  fatal.  The  initial  point  is  more  fre- 
quently some  part  of  the  skin  (where  scratched  or  broken)  than 
the  nasal  mucosa;  there  a  nodule  appears,  with  swelling  and 
lymphangitis.  In  the  acute  form  the  onset  is  usually  violent,  with 
high  fever  and  grave  systemic  symptoms.  A  general  papular 
eruption  may  occur,  soon  becoming  pustular  and  simulating  variola. 
The  chronic  form  is  much  like  that  of  the  horse,  with  the  same  foul 
discharging  ulcerations,  but  is  more  frequently  fatal. 

To  diagnose  glanders  in  horses,  mallein,  the  endotoxin  of  B.  mal- 
lei, is  frequently  and  successfully  used,  its  injection  into  an  in- 
fected animal  being  followed  within  a  few  hours  by  a  sharp  rise  of 
temperature. 

The  general  prophylaxis  consists  in  the  killing  and  burial  of  in- 
fected animals,  and  disinfection.  Great  care  should  be  taken  by  all 
persons  handling  diseased  horses  or  mules  to  prevent  any  discharge 
from  the  nose  or  sores  of  these  animals  coming  in  contact  with 
wounds  or  scratches  on  their  bodies,  or  being  blown  in  their  faces. 

LEPROSY. 

A  widespread  chronic  infectious  disease,  most  common  in  China, 
India  and  Japan,  but  found  in  nearly  all  countries,  including  the 
United  States  and  its  colonies.  The  Bacillus  leprcc  is  accepted  as 
the  cause,  but  the  manner  of  its  introduction  into  the  body  and  the 
conditions  favoring  it  are  still  uncertain.  It  seems  probable  that 
the  infection  is  by  inhalation  of  the  bacillus,  and  absorption  through 
the  mucosa  of  the  nasopharynx,  as  the  result  of  prolonged  and  inti- 
mate association  with  patients.  Prophylaxis  consists  in  segregation 
and  isolation  of  patients. 

According  to  the  Public  Health  Service,  there  were,  in  1915,  over 
200  lepers  (of  whom  102  were  in  Louisiana)  in  the  United  States, 
670  in  Hawaii,  4,472  in  the  Philippines  and  37  in  Porto  Rico.  In 
Cuba  there  are  at  least  200.  Too  many  lepers  have  complete  free- 
dom of  movement  and  action  in  this  country,  and  are  a  menace  to 
their  families  and  people  they  associate  with.  A  suitable  home, 
tinder  federal  authorities,  should  be  provided  for  them. 

Since  the  occupation  of  the  Philippines,  to  1910,  there  have  only 
been  three  cases  of  leprosy  among  Americans  in  the  Islands,  all  of 
whom  gave  a  history  of  excessive  sexual  indulgence  with  native 
women. 


INFECTIOUS   DISEASES    (CONTINUED).  IO3 

YAWS    (FBAMBOESIA). 

Yaws  is  a  highly  contagious,  inoculable  chronic  disease  charac- 
terized by  mild  constitutional  disturbance  and  eruptions  of  fungoid 
incrusted  tubercles.  Common  in  Africa,  the  West  Indies  and  parts 
of  India.  Not  rare  in  some  of  the  Philippine  Islands  among  the 
very  poor  and  ignorant,  but  seldom  seen  in  Manila.  The  causative 
agent  is  a  minute,  spirally-twisted  organism  or  spirochete,  the 
Treponema  pertenue  of  Castellani,  which  so  closely  resembles  the 
T.  pallidum  of  syphilis  that  few  bacteriologists  claim  to  differentiate 
them.  The  disease  itself  suggests  syphilis  and  may  prove  to  be  a 
form  of  it,  but  is  clinically  distinct. 

For  its  production,  simple  skin  contact  is  not  sufficient;  a  break 
of  surface,  previous  sore  or  ulcer  is  necessary.  Probably  the  virus 
can  be  conveyed  by  insects. 

CLIMATIC    BUBO. 

A  form  of  non-specific  adenitis  found  in  all  warm  countries,  and 
always  causing  a  few  admissions  to  the  sick  report  among  our  troops 
in  the  colonies.  The  inguinal  and  crural  glands  are  those  generally 
affected;  they  may  swell  to  the  size  of  a  hen's  egg  or  even  larger, 
and  occasionally  suppurate.  The  cause  of  this  affection  has  not  yet 
been  determined,  but  it  is  probably  of  an  infectious  nature  and 
transmitted  by  some  biting  insect. 

LEISHMANIASIS. 

Under  this  heading  are  included  three  distinct  diseases  caused  by 
different  varieties  of  Leishmania,  an  intracellular  roundish  pro- 
tozoon  containing  two  nuclei,  one  oval,  the  other  smaller  and  rod- 
shaped,  i,  Kala-Azar,  a  highly  fatal  infection  of  India  and  other 
parts  of  Asia,  attacking  both  sexes  at  all  ages ;  caused  by  L.  dono- 
vani.  2,  Infantile  Kala-Azar,  prevailing  in  all  countries  -bordering 
the  Mediterranean,  but  restricted  to  children  between  2  and  5  years ; 
caused  by  L.  infantum.  3,  Tropical  or  Oriental  Sore,  a  benign 
ulcerating  affection  of  the  skin  common  in  the  tropical  regions  of 
the  Old  and  New  Worlds;  caused  by  L.  tropica.  For  the  3  years 
1909-1911,  26  cases  of  tropical  sore  were  reported  from  the 
American  troops  in  the  Philippines. 

These  three  varieties  of  the  parasite  are  much  alike,  and  Leish- 
man  was  unable  to  detect  any  constant  differential  features  between 


IO4  MILITARY    HYGIENE. 

them.  Kala-Azar  is  probably  transmitted  by  bedbugs.  The  infan- 
tile form  is  transmitted  from  the  dog  by  fleas.  The  mode  of 
transmission  of  the  tropical  sore  is  not  yet  known. 

TRYPANOSOMIASIS  (SLEEPING  SICKNESS). 
An  almost  always  fatal  African  disease  caused  by  a  spindle- 
shaped  blood  protozoon,  Trypanosoma  gambiense,  transmitted  by 
several  "  Tsetse  flies,"  small  brownish  biting  flies  of  the  genus  Glos- 
sina,  chiefly  G.  Palpalis  and  G.  morsitans.  (See  page  156.)  The 
latter  species  also  transmits  T.  brucei,  cause  of  the  widespread  cattle 
disease,  nagana,  in  Africa.  Another  trypanosome  (T.  evansi), 
apparently  transmitted  by  several  kinds  of  biting  flies,  causes  the 
"  surra  "  of  horses  and  mules  in  India  and  the  Philippines. 


MILITARY  HYGIENE  — HAVARD 


PLATE  VI. 


1.  Trypanosoma  gambiense ;  trypanosome  of  sleeping  sickness. 

2.  Leishmania  donoram;  splenic  smear  from  case  of  kala-azar. 

3.  Trcponcma  pallidum  of  syphilis  in  chancre. 

4.  Treponema  pertenue  of  yaws  in  section  of  skin. 

5.  Embryo  of  Filaria  bancrnfti  in  fresh  human  blood. 


CHAPTER  IX. 
PARASITIC    DISEASES. 

Under  this  heading  are  included  diseases  caused  by  various  para- 
sites other  than  bacteria  and  protozoa. 

PARASITES  OF  THE  CIRCULATORY  AND  LYMPHATIC  SYSTEMS. 

Filariasis  is  the  condition  resulting  from  the  presence  in  blood- 
vessels and  lymphatics  of  minute,  filiform  nematode  worms  belong- 
ing to  several  species  of  Filaria.  Only  one,  F.  bancrofti,  appears 
to  have  important  pathological  bearings.  It. is  the  most  common 
and  widespread.  In  the  adult  stage  it  inhabits  the  lymphatics  of 
man ;  there  fecundation  occurs,  soon  followed  by  the  pouring  out 
of  new  generations  (microfilarias)  which  find  their  way  into  the 
circulation.  In  most  cases  of  filariasis  the  parasite  seems  to  exer- 
cise no  injurious  influence,  except  mechanically  by  obstructing  the 
lymphatics.  In  this  way  are  produced  various  complications  such 
as  chyluria,  lymph  varix,  lymph  scrotum  and  probably  elephantiasis. 
F.  bancrofti  exhibits  a  remarkable  day  and  night  periodicity,  being 
absent  from  the  peripheral  circulation  during  the  day  and  usually 
abundant  at  night. 

This  disease,  with  all  its  complications,  has  a  very  extensive  dis- 
tribution throughout  all  tropical  and  subtropical  countries  where  a 
notable  proportion  of  the  poorer  natives  are  often  infected  with  it, 
and  is  therefore  always  a  menace  to  our  soldiers  in  the  colonies, 
several  of  whom  have  already  suffered  from  it.  According  to 
Phalen  and  Nichols,  an  average  of  2  per  cent,  of  the  population  of 
the  Philippine  Islands  is  infested  with  filaria.  These  observers 
record  that  among  250  American  soldiers  stationed  18  months  in 
one  of  'the  most  highly  infested  filarial  districts  of  the  Islands,  not 
a  single  case  occurred,  indicating  how  easily  white  people  can  be 
protected  from  this  parasite. 

Filariasis  is  a  mosquito-borne  disease,  being  transmitted  to  man 
by  Cule.v  fatigans  and  probably  other  insects.  Man  is  the  definite 
host  of  this  blood-worm  and  the  mosquito  only  the  intermediary 
host  (Plate  VI). 

Ashburn  and  Craig  have  discovered  another  species  (F.  Philip- 

105 


IO6  MILITARY    HYGIENE. 

pinensis)  in  the  blood  of  Filipinos,  likewise  transmitted  by  Culex 
fatigans. 

The  prophylaxis  of  filariasis  is  that  of  all  mosquito-borne  dis- 
eases, namely,  destruction  of  mosquitoes  and  protection  from  their 
bites. 

Bilharziasis  (Bilharz's  disease)  is  caused  by  several  species  of 
Schistosomum  (Bilharsia},  trematode  or  fluke  worm,  in  the  blood 
and  lymph.  5\  hccmatobium,  of  Africa,  lodges  mostly  in  the  walls 
of  the  bladder,  causing  chronic  hematuria;  5".  mansonl,  of  the  West 
Indies,  inhabits  chiefly  the  mesenteric  veins  and  gives  rise  to  dysen- 
teric symptoms ;  5\  japonicum,  of  Japan  and  China,  is  not  very  rare 
in  the  Philippine  Islands;  it  attacks  specially  the  liver,  spleen  and 
intestines. 

Paragonomiasis,  not  uncommon  in  the  Philippines,  is  a  disease 
caused  by  the  Paragonimus  westermani,  an  oval  reddish-brown  fluke, 
half -inch  long,  inhabiting  chiefly  the  lungs  but  more  rarely  also  the 
liver  and  brain.  It  is  readily  diagnosed  by  a  chronic  cough,  hemop- 
tysis, and  the  characteristic  ova  in  the  rusty-brown  sputum. 

Clonorchis  endemicus  (C.  sinensis),  a  narrow  oblong  parasite,  10 
to  20  mm.  in  length,  inhabits  the  bile  ducts  and  gall-bladder.  Very 
common  in  Japan  and  China  and  not  rare  in  the  Philippines. 

INTESTINAL  PARASITES. 

In  the  United  States,  the  most  common  intestinal  parasites, 
according  to  Stiles  and  Garrison  (1906),  are  the  following: 

Per  cent,  of  population 

in  which  found. 

Trichuris  trichiura  (Trichocephalus  trichiurus)  Whip- 
worm,  7-69 
Qxyuris  vermicularis ,  Pinworm,  1 . 30 
Necator  Americamis,  New  World  Hookworm,          ] 
Ankylostomum  duodenale,  Old  World  Hookworm,  ^ 
Ascaris  lumbricoides,  Eelworm,  Roundworm,                 0.49 
Hymenolepis  nana,  Dwarf  Tapeworm,                             O-35 
SWongyloides  stercoralis,  Cochin-China  Worm,             0.23 
Tccnia  saginata,  Fat  Tapeworm,                                      0.06 
From  an  examination  of  the  stools  of  1,280  patients  in  the  Phila- 
delphia General  Hospital,  Rosenberg  found  170  harboring  parasites, 
or  13  per  cent. 


MILITARY  HYGIENE— HAVARD 


PLATE  VII. 


\ 


1.  Ovum  of  Ascaris  Inmbricoides. 

2.  Larvae  of  Strongyloidcs  stercoralis  in  fresh  stool. 

3.  Ovum  of  Necator  americanus  in  fresh  stool. 

4.  Unhatched  larva  of  Necator  americanus  in  fresh  stool. 

5.  Adult    Necator    americanus,    showing    head    of    worm    attached    to    the 

mucous  membrane  of  the  intestine. 

6.  Ovum  of  Tricocephalus  trichiurus. 


PARASITIC   DISEASES.  IO7 

These  figures  appiy  mainly  to  the  middle  and  northern  States.  In 
most  of  the  southern  States  it  is  well  known  that  the  percentage  of 
individuals  affected  with  hookworm  far  exceeds  that  of  individuals 
harboring  all  other  parasites  combined. 

From  an  examination  of  the  stools  of  applicants  for  enlistment 
from  the  southern  States,  at  Columbus  Barracks,  O.,  in  1910,  Love 
ascertained  that  37.50  per  cent,  were  infested  with  one  or  more 
kinds  of  parasites,  Nccator  being  found  in  24.62  per  cent.,  Ascaris 
in  14.77,  Strongyloidcs  in  4.93  and  Trichuris  in  3.41. 

In  Porto  Rico,  the  prevalence  of  intestinal  parasites  was  as  fol- 
lows in  1904 :  Per  cent  of  population. 
Necator  Americanos,  90  to  100 
Ascaris  lumbricoides,  3!-4i 
Trichuris  trichiura,  7-27 
Strongyloides  stercoralis,                                                  0.80 
Oxyuris  vermicularis,                                                         0.07 

Since  1904  the  above  prDportion  of  Necator  has  been  greatly 
reduced. 

In  the  Philippine  Islands,  not  less  than  80  per  cent,  of  the  popula- 
tion is  infested  with  one  of  more  kinds  of  intestinal  parasites,  so 
that  if  the  different  species  are  separately  considered  there  is  an 
average  of  about  200  infections  to  each  100  of  population  (Gar- 
rison}. The  most  common  species,  in  order  of  prevalence,  are 
Ascaris,  Trichuris  and  the  hookworms.  There,  as  in  many  other 
tropical  countries,  ideal  conditions  often  exist  for  the  propagation 
and  dissemination  of  parasites,  namely :  crowding  of  dwellings, 
absence  of  privies,  scattering  of  excrements  or  use  as  fertilizer, 
questionable  water-supply,  disregard  of  personal  cleanliness,  practice 
of  eating  off  common  dishes  with  dirty  fingers,  lack  of  footwear. 

As  a  remarkable  indication  of  the  detrimental  effect  of  intestinal 
parasites  in  the  tropics,  even  in  the  absence  of  obvious  symptoms, 
may  be  noted  the  fact  that  the  mortality  of  the  Bilibid  prison  (P.  I.), 
in  spite  of  satisfactory  sanitary  conditions,  remained  at  75  per  1,000 
until  the  prisoners  were  systematically  treated  for  parasites,  after 
which  the  death  rate  dropped  to  about  13  per  1,000  (Garrison}. 

Outside  of  the  hookworms  and  the  tapeworms  in  certain  regions, 
the  large  roundworm  (Ascaris}  seems  to  be  the  most  prevalent  of 
intestinal  parasites  in  all  parts  of  the  world.  The  eggs  are  readily 
recognized  by  their  rough,  mamillated  shell ;  they  are  endowed 


IO8  MILITARY    HYGIENE. 

with  remarkable  vitality,  lasting  at  least  four  months  in  moist  feces 
after  being  passed  from  the  intestines,  as  shown  by  Stiles.  This 
worm  is  also  found  in  cattle  and  hogs,  and  the  eggs  may  be  con- 
veyed with  the  excrements  of  these  animals  to  the  vegetable  garden 
or  washed  into  the  water  supply. 

The  reports  of  the  Surgeon  General  for  1910  and  1911  show 
that  next  to  the  hookworms,  the  most  common  intestinal  parasites 
among  troops  serving  in  the  United  States  are,  in  order  of  preva- 
lence, Tccnia  saginata,  T.  solinm,  Ascaris,  Bothriocephalus  and 
O.ryuris.  In  the  Philippines,  Ascaris  is  more  prevalent  than  Tccnia. 
Ankylostomiasis.  —  The  hookworms,  both  Old  World  and  New 
World  species,  are  not  only  the  most  prevalent  of  intestinal  parasites 
in  many  regions,  but  also  the  most  dangerous,  producing  a  form  of 
anemia  known  as  ankylostomiasis. 

The  Old  World  Hookworm  (Ankylostomum  dnodenale  or  Unci- 
naria  duodenalis}  is  about  half-inch  in  length  (the  male  often  less, 
but  the  female  generally  more),  the  thread-like  body  tapering  to  a 
narrow  neck  ending  in  a  mouth  cavity  armed  with  4  hooks  and  2 
conical    teeth.      (Fig.     n.)      It    inhabits    the 
upper  part   of   the   small   intestine,   where   it 
attaches   itself   to  the  mucous  membrane  by 
means  of  its  strong  buccal  armature,  sucking 

the  blood  out  of  it   (Plate  VII).     The  male, 
FIG.  ii. —  Ankylosto-       i       •  ,         ,     •  „         ,,  ,.         ,         , 

mum  duodenale         besides    being    smaller    than    the    female,    is 

(natural  size).  recognized  by  the  caudal  umbrella-like  expan- 

a  Male"  &" female        s^on    (copulatory    bursa).     The    female    pro- 
duces a  prodigious  number  of  eggs  which  pass 

out  in  the  feces,  thus  betraying  the  presence  of  the  parasite.  (Plate 
VII.)  These  ova,  under  the  microscope,  are  clear  and  transparent, 
with  regular  oval  form  and  delicate  shell  through  which  can  easily 
be  seen  4  to  6  grayish  yolk  segments.  They  generally  have  to  be 
differentiated  under  the  microscope  from  those  of  the  two  most 
common  intestinal  parasites,  the  roundworm  and  the  whipworm ; 
these  are  both  bile-stained,  the  former  having  a  tu'berculated  shell. 
the  latter  looking  like  an  oval  platter  with  handles.  (Plate  VII.) 
Outside  of  the  intestine  the  hookworm  ova  undergo  rapid  changes, 
and  the  embryo  is  born  within  one  or  two  days.  After  reaching  a 
certain  development,  the  minute  larva,  about  0.5  mm.  long,  whether 
in  water,  mud  or  sand,  remains  in  a  torpid  condition  waiting  for  a 


PARASITIC   DISEASES.  ICK) 

chance,  should  it  survive,  to  be  transferred  to  the  human  alimentary 
canal,  where  it  acquires  sexual  characters  and  permanent  adult  form. 
Thus  it  appears  that,  although  the  eggs  are  produced  in  the  intestine, 
there  is  no  hatching  in  the  human  body,  and  therefore  no  reinfection, 
except  from  the  outside. 

The  ova  in  feces,  as  when  passed  in  latrines,  hatch  in  due  course, 
but  the  embryos  soon  die  unless  supplied  with  air  and  earth. 

The  larvae  find  their  way  to  the  human  intestine  chiefly  by  boring 
through  the  skin ;  then,  entering  the  blood-vessels  and  lymphatics, 
they  are  carried  to  the  lungs  and  ascend  the  trachea  until  the  eso- 
phagus is  reached,  whence  they  pass  to  the  stomach  and  small  intes- 
tine. This  mode  of  entrance  is  the  usual  one  in  the  case  of  farm 
laborers  walking  on  infected  soil  with  bare  feet.  The  result  is  the 
condition  known  as  "  ground  itch."  Its  symptoms  are  a  stinging 
sensation  in  the  feet  and  legs,  followed  by  intolerable  itching  for 
several  days,  then  vesiculation  and  incrustation.  Within  two  months 
the  ova  may  be  found  in  the  stools.  Infestation  is  also  possible  by 
ingestion  of  contaminated  water  or  food,  but  this  is  thought  to  be 
comparatively  rare. 

This  parasite  occurs  nearly  in  all  but  the  most  northern  countries, 
being  abundant  in  the  south  of  Europe  as  well  as  in  the  tropical  and 
subtropical  regions  of  Asia  and  Africa,  and  common  in  America. 
It  is  most  prevalent  in  southern  China,  Japan,  India  and  northern 
Africa,  where  at  least  75  per  cent,  of  all  natives  are  infested.  It  is 
found  in  most  of  the  mines  of  the  United  States  and  Mexico,  having 
been  implanted  therein  by  foreign  workmen. 

The  hookworm  disease  (as  caused  by  both  Ankylostomum  and 
Necator)  belts  the  earth  with  a  zone  about  66  degrees  in  width, 
namely,  from  36°  lat.  north  to  30°  lat.  south.  Both  species  are 
common  in  China  and  Japan,  but  only  the  former  is  found  in  India. 
In  Panama  both  species  are  found,  but  seldom  in  sufficient  number 
to  produce  noticeable  symptoms. 

The  New  World  Hookworm  (Necator  Americantis} ,  differentiated 
and  described  by  Stiles  in  1902,  is  abundant  in  the  Southern  States, 
Porto  Rico,  Cuba  and  very  likely  in  Central  America ;  also  a  com- 
mon parasite  in  the  Philippine  Islands,  and  likewise  found  in  certain 
parts  of  Africa.  In  the  United  States  it  occurs  in  a  large  propor- 
tion of  the  population,  white  and  colored,  from  New  York  and 
Illinois  southward  and  westward  to  Florida,  Louisiana  and  Texas, 


no 


MILITARY    HYGIENE. 


especially  among  the  rural  farming  classes  of  sandy  zones,  being 
most  abundant  in  central  Tennessee  and  the  sandy  coastal  plains  of 
Virginia,  North  and  South  Carolina,  Georgia,  Alabama  and  Missis- 
sippi. It  is  estimated  that,  in  Georgia,  one- fourth  of  the  total  white 
population  is  infested.  The  negro  is  much  less  susceptible  than  the 
white.  The  period  of  life  most  affected  is  from  6  to  16  years,  so 
that  in  the  schools  an  incidence  of  75  to  80  per  cent,  is  not  unusual. 
Chamberlain  found  that  at  least  60  per  cent,  of  southern-bred 
recruits  were  infested.  In  four  North  Carolina  militia  regiments, 
Strosnider  found  the  percentage  of  infestation  to  range  from  30 
to  58. 

The  Necator  is  distinguished  from  the  Ankylostomum  by  a  smaller 
mouth  armed  with  semilunar  plates  instead  of  hooks.  The  female 
has  the  same  length  (11—12  mm.)  in  both  species.  The  ovum  is 
larger.  (Fig.  12.) 


Male.  Female. 

FIG.  12. —  Necator  Americanus.     (Manson.) 


PARASITIC   DISEASES.  Ill 

Often,  hookworms  in  the  intestine,  especially  if  few  in  number, 
give  rise  to  no  appreciable  symptoms.  But  if  numerous  they  may, 
in  poorly  nourished  subjects,  especially  those  already  suffering  from 
some  chronic  exhausting  disease,  give  rise  to  a  severe  form  of 
anemia  leading  to  permanent  degeneration  of  important  organs  and 
death.  The  chief  symptoms  are :  depraved  appetite,  with  gastric 
and  intestinal  disturbances ;  marked  retardation  of  general  develop- 
ment, with  weak,  flabby  muscles,  serous  effusions  into  the  sub- 
cutaneous tissues,  retinal  hemorrhage,  night  blindness,  etc.  The 
mind  is  slow  and  torpid.  The  Ankylostomum  sucks  blood  from  the 
mucous  membrane  (as  shown  in  fig.  5,  plate  VII)  ;  not  so  with 
Necator  which  feeds  only  on  epithelial  cells.  Both,  however,  pro- 
duce a  constant  drain  on  the  system,  and,  through  the  minute 
wounds,  a  greater  susceptibility  to  the  attacks  of  infectious  bacteria. 
It  is  also  believed  that  additional  harm  is  done  by  a  poisonous  sub- 
stance secreted  by  the  worm.  In  the  southern  Atlantic  States, 
ankylostomiasis  must  be  considered  one  of  the  most  common  and 
widespread  diseases,  especially  among  the  lower  classes  of  white, 
being  even  more  prevalent,  in  rural  sand  districts,  than  tuberculosis 
and  malaria.  It  accounts  for  the  fact  that  a  large  proportion  of  the 
recruits  for  the  Army  from  the  Southern  States  are  under-developed 
and  physically  inferior  to  northern-bred  men  of  the  same  age.  In 
Porto  Rico,  before  1904,  from  5,000  to  7,000  natives  died  from  it 
annually,  while  70  per  cent,  of  the  worm-carriers  were  more  or  less 
incapacitated  in  consequence  of  it  (Ashford).  In  the  Philippine 
Islands  both  kinds  of  worms  are  found,  but  the  Necator  predomi- 
nates. Among  the  general  population  of  Luzon  the  percentage  of 
infestation  was  found  to  range  from  n  to  16,  and  to  reach  29  among 
the  natives  of  the  northern  mountains ;  it  has  exceeded  50  in  the 
scout  companies  and  among  the  inmates  of  the  Bilibid  Prison.  It 
is  remarkable  that,  in  these  Islands,  severe  clinical  manifestations  of 
ankylostomiasis  are  comparatively  rare,  and  that  there  is  no  preva- 
lence of  anemia  nor  of  any  other  symptoms  among  the  natives 
attributable  to  the  hookworm.  This  is  probably  due  to  the  fact 
that,  although  many  individuals  are  infested,  the  number  of  parasites 
in  each  is  generally  small. 

Prophylaxis. —  Since  the  parasite  is  spread  through  the  stools  of 
patients,  fecal  contamination  of  soil  and  water  must  be  carefully 
prevented  by  compelling  all  people  concerned  to  use  privies.  Cleanly 


112  MILITARY    HYGIENE. 

habits  and  the  wearing  of  shoes  should  be  insisted  upon.  The  sys- 
tematic administration  of  thymol  or  betanaphthol  to  all  persons 
affected  or  suspected,  to  expel  the  worm,  has  produced  excellent 
effects  in  Porto  Rico.  Permanent  practical  results  can  only  be 
expected  after  a  patient  and  persistent  campaign  of  education. 

Thymol  is  recognized  as  the  best  all-round  remedy  against  hook- 
worm, and  betanaphthol  the  next  best.  After  a  fast  of  12  to  24 
hours  and  a  purge,  thymol  is  given  in  capsules,  the  quantity  (from 
0.5  to  4  grams)  being  divided  into  two  doses  administered  one  hour 
apart. 

SKIN  PARASITES. 

Skin  diseases  are  now  much  less  common  than  formerly  in  the 
Army  and  Navy.  True  itch,  or  scabies  (see  page  141),  is  becom- 
ing rare.  It  has  been  found,  in  the  Navy,  to  involve  oftener  the 
gluteal  folds  and  dorsum  of  penis  than  the  hands,  indicating  its 
transmission  by  the  seats  of  water-closets.  In  the  tropics,  the 
so-called  "  dhobie  itch  "  is  not  infrequently  seen  among  our  soldiers. 
Although  the  name  is  applied  to  various  itching,  ringworm-like 
affections,  it  usually  refers  to  some  form  of  bacterial  intertrigo  of 
the  crotch  and  axillae.  In  hot  and  damp  weather  the  germs  pro- 
liferate actively,  causing  excessive  irritation  and  scratching.  "  Camp 
itch  "  is  an  indefinite  term  applied  to  various  itching  skin  affections, 
generally  beginning  with  papillary  inflammation  which,  when  com- 
plicated with  filth  and  scratching,  may  become  eczematous;  its  treat- 
ment should  always  begin  with  water  and  soap. 

The  following  parasitic  skin  diseases  are  also  mentioned  on 
account  of  their  comparative  frequency: 

Tinea  circinata  or  Ringworm,  caused  by  the  fungus  Trichophyton 
tonsurans,  appears  upon  both  the  hairy  portions  of  the  body  as  well 
as  upon  free  skin,  forming  circular  scaly  patches  within  which  the 
hair  falls  out.  Occurs  mostly  in  children. 

Tinea  imbricata  or  Tropical  Ringworm,  is  prevalent  in  most  warm 
countries,  "  characterized  by  a  concentric  arrangement  of  closely-set 
rings  of  scaling  epidermis  "  (Manson},  from  one-eighth  to  half-inch 
apart,  and  without  dermatitis.  All  parts  of  the  body  may  be 
involved  except  the  scalp,  crotch  and  axillae.  Each  scale,  under  the 
microscope,  shows  an  enormous  profusion  of  a  trichophyton  fungus, 
the  causal  organism. 


PARASITIC   DISEASES.  113 

Pemphigus  contagiosus,  a  non- febrile,  highly  contagious  affection 
of  tropical  countries,  beginning  with  minute  papules  which  rapidly 
mature  into  vesicles,  bullae  or  even  large  blebs.  These  are  round, 
with  well  denned  margins  and  no  areola  of  congestion.  After  rup- 
ture of  the  blisters  a  process  of  desquamation  sets  in,  extending  to 
the  surrounding  skin.  Any  part  of  the  body  may  be  affected  but, 
in  adults,  the  disease  is  mostly  confined  to  axillae  and  crotch. 
There  is  an  entire  absence  of  constitutional  symptoms.  The  causal 
organism  has  not  yet  been  determined. 

Common  in  most  countries  is  Favus,  caused  by  several  forms  of 
the  fungus  Achorion.  It  attacks  chiefly  the  scalp  of  ill-nourished 
children,  forming  small  sulphur-yellow  cupped  crusts  at  the  base 
of  the  hair.  It  is  rarely  seen  among  our  soldiers. 


CHAPTER  X. 
NUTRITIONAL  DISEASES. 

PELLAGRA. 

An  endemic,  non-contagious  disease  of  slow  evolution,  character- 
ized by  various  cutaneous,  gastric  and  nervous  symptoms,  most 
marked  in  the  spring  and  early  summer  months. 

It  is  of  comparatively  modern  origin,  having  been  first  observed 
in  Italy  and  Spain  in  the  middle  of  the  XVIIIth  century,  then 
gradually  spreading  to  all  countries  of  southern  Europe  and 
northern  Africa.  Although  first  discovered  in  the  United  States 
only  a  few  years  ago,  it  has  now  become  so  prevalent  in  some  of  the 
Southern  States  as  to  constitute  one  of  the  most  important  health 
problems  of  the  day.  Thousands  of  cases  have  been  reported  from 
more  than  thirty  States,  especially  Ky.  Tenn.,  N.  Car.,  S.  Car.  and 
Ga. 

The  skin  symptoms  are  characteristic.  An  erythema,  like  a  severe 
sunburn,  in  irregular  patches,  appears  suddenly,  first  on  the  back 
of  hand  and  feet,  then  on  forearms,  legs  and  other  parts  usually 
exposed  to  the  sun.  It  lasts  about  two  weeks,  leaving  the  skin 
rough  and  thickened  (pellagra  meaning  rough  skin).  The  tongue 
and  other  parts  of  the  mouth  become  inflamed  and  denuded. 
Gastro-intestinal  disturbances  are  usually  present.  There  is  also 
great  weakness  and  emaciation.  The  patient  becomes  irritable, 
morose,  and  suffers  from  attacks  of  giddiness.  All  these  symptoms 
may  greatly  improve  or  almost  disappear  before  winter,  but  always 
recur  the  following  spring  in  a  more  severe  form.  His  depression 
of  spirits  deepens  into  melancholia  and,  in  time,  he  becomes  paralytic 
and  completely  demented.  It  is  estimated  that,  in  this  country,  50 
per  cent,  of  the  cases  die  during  the  first  two  years: 

The  etiology  of  pellagra  has  been  the  object  of  numerous  investi- 
gations, for  until  this  was  discovered  no  decided  progress  in 
prophylaxis  and  treatment  was  possible.  The  Italian  theory,  until 
recently  widely  accepted,  is  that  pellagra  is  caused  by  the  toxins 
of  mouldy  maize.  According  to  Sambon,  who  first  advanced  this 
view,  it  is  produced  by  a  protozoal  parasite  probably  transmitted, 
in  southern  Europe,  by  a  blood-sucking  fly,  Simiilinm  reptans,  and 

114 


PARASITIC   DISEASES.  1 15 

in  this  country  by  other  species  of  the  same  genus,  such  as 
S.  pecuarum  (buffalo  gnat),  S.  pictipes  and  others  (see  page  157). 

Fortunately  the  persistent  observations  and  experiments  of  the 
Public  Health  Service,  during  a  number  of  years  and  completed  in 
1916,  have  finally  settled  this  most  important  and  troublesome 
question.  It  is  now  established  that  pellagra  is  a  deprivation  disease 
resulting  from  a  faulty  diet  containing  an  excess  of  carbo-hydrates 
and  deficient  in  certain  food  elements  (vitamines)  generally  supplied 
in  milk,  eggs,  fresh  meat,  beans  and  peas.  It  was  found  that  corn 
bread  prepared  by  means  of  baking  soda,  without  the  addition  of 
buttermilk  or  sour  milk,  is  deficient  in  vitamines  owing  to  the 
destructive  action  of  the  alkali  upon  them. 

The  prevention  of  pellagra,  therefore,  consists  simply  in  a  well- 
balanced  diet,  with  a  sufficiency  of  animal  protein  foods  and 
legumes,  and  free  from  any  excess  of  carbo-hydrate  components. 

BERIBERI   OB   KAKKE. 

A  specific,  non-infectious,  acute  or  chronic  form  of  multiple 
peripheral  neuritis,  endemic  in  Japan  and  China  and,  to  a  lesser 
extent,  prevalent  in  most  tropical  and  subtropical  countries.  In 
Manila  alone,  1,002  cases  were  reported  during  the  year  1910.  It 
was  the  disease  which  most  disabled  the  Japanese  troops  in  the 
Russo-Japanese  War. 

A  disease  exceedingly  variable  in  the  nature  and  severity  of  its 
symptoms,  generally  assuming  one  of  two  forms,  the  paralytic- 
atrophic  (dry  beriberi)  or  the  dropsical  (wet  beriberi),  or  various 
combinations  of  them  (mixed  beriberi)  ;  death,  when  it  occurs, 
being  usually  the  result  of  heart  paresis. 

Cause. —  The  cause  of  beriberi  has  now  been  sufficiently  elucidated 
to  enable  us  to  control  this  disease  and  prevent  its  development. 
Until  recently,  owing  to  its  peculiar  endemic  and  localized  char- 
acter, beriberi  was  generally  believed  to  be  a  place  disease  produced 
by  a  germ  breeding  in  certain  soils  or  buildings  under  the  influence 
of  dirt  and  other  unhygienic  conditions.  To-day  the  germ  theory 
has  but  few  supporters.  The  persistent  researches  carried  on  in 
the  Philippines,  chiefly  by  boards  of  Army  medical  officers,  as  well 
as  in  the  Malay  Peninsula  by  English  physicians,  have  established 
the  fact  that  beriberi  is  a  disease  of  nutrition,  the  result  of  the 
lack  in  the  dietary,  of  certain  essential  elements.  It  is  not  improb- 


Il6  MILITARY    HYGIENE. 

able,  however,  that  camps  or  buildings  in  which  beriberi  prevails 
may  become  contaminated  by  secondary  germs  or  toxins  which, 
although  non-specific  as  regards  the  transmission  of  the  disease, 
render  exposed  persons  more  susceptible  to  it.  Thus  might  be 
explained  its  apparent  epidemic  character  under  certain  circum- 
stances. 

Experiments  by  Strong  and  Crowel,  in  Manila,  upon  prisoners 
under  sentence  of  death,  who  volunteered  for  the  purpose,  furnish 
definite  evidence  that  beriberi  is  due  to  the  prolonged  consumption 
of  a  diet  lacking  certain  substances  (vitamines)  necessary  for  the 
normal  physiological  needs  of  the  body,  while  there  is  none  sug- 
gesting that  it  is  an  infectious  disease. 

The  fact  that  beriberi  is  generally  found  in  races  which  use  rice 
as  a  more  or  less  exclusive  article  of  diet,  long  since  called  attention 
to  this  food  as  the  possible  cause  of  it.  Some  years  ago,  when 
beriberi  was  disabling  at  least  one-fourth  of  the  Japanese  Navy,  a 
change  was  made  in  the  ration  at  the  suggestion  of  Takaki,  consist- 
ing in  the  reduction  of  the  rice  component  and  the  increase  of  other 
vegetables  richer  in  nitrogen.  The  result  was  the  almost  complete 
disappearance  of  this  disease ;  but  as  other  hygienic  reforms  were 
instituted  at  about  the  same  time,  the  chief  cause  of  this  great 
improvement  in  the  health  of  the  crews  was  not  made  manifest. 

A  few  remarks  about  the  structure  and  composition  of  the  rice 
grain  will  be  useful  for  the  better  comprehension  of  the  subject. 
It  consists  of  the  small  embryo,  the  endosperm,  the  episperm  or  seed 
coat  and  the  skin  or  pericarp,  all  of  which  parts  are  closely  coales- 
cing, so  that  the  episperm  is  not  distinguishable.  Outside  are  the 
glumes  (husk)  which  adhere  to  the  grain.  Rice  with  the  husk  still 
on  is  called  "  padi  "  by  the  English,  and  "  palay  "  in  the  Philippines. 
Under  the  microscope  can  be  seen  the  flattened  and  dried  cells  of 
the  husk,  then  the  elongated  cells  of  the  pericarp  in  one  or  two 
layers,  and  within  these  the  large  polygonal  cells  of  the  endosperm 
filled  with  very  numerous  and  minute  angular  starch  grains.  The 
framework  of  the  cells  itself  consists  largely  of  protein.  The  thin 
outer  portion  of  the  endosperm,  called  the  aleurone  layer,  contains 
albuminous  material  and  most  of  the  fat.  The  pericarp  contains 
also  albuminous  material,  as  well  as  phosphorus  and  potassium  in 
notable  proportion.  The  color  of  the  pericarp  varies  from  white  to 
yellow,  red  and  nearly  black.  The  common  varieties  grown  in  the 


PARASITIC    DISEASES.  1 1/ 

Philippines  have  the  pericarp  either  brick-red  or  yellowish-white. 
Rice,  when  prepared  for  consumption,  is  polished  or  milled,  that 
is  to  say,  not  only  husked  but  its  pericarp  ground  off ;  in  this  process 
more  or  less  of  the  aleurone  layer  is  also  removed.  As  a  result  of 
milling,  a  certain  proportion  of  nitrogenous  matter  is  lost ;  thus 
while  raw  rice  often  contains  10  per  cent,  of  protein,  polished  rice 
seldom  contains  more  than  7.  The  loss,  however,  is  especially  great 
in  phosphorus  and  potassium,  rice  only  superficially  polished,  or 
undermilled,  containing  at  least  twice  as  much  of  these  substances 
as  the  regularly  polished  grain. 

Experiments  on  a  large  scale  conducted  during  the  last  few  years 
in  the  Philippines  and  the  Malay  Peninsula,  under  varying  condi- 
tions, have  conclusively  proved  that  a  dietary  consisting  chiefly  of 
polished  rice  will  almost  certainly  result  in  a  certain  proportion  of 
cases  of  beriberi,  and  that  as  soon  as  the  polished  rice  is  replaced 
by  unpolished  or  undermilled  grain  beriberi  will  cease.  In  accord- 
ance with  this  finding,  the  Tropical  Disease  Board  recommended  a 
change  in  the  ration  of  the  Philippine  scouts ;  the  rice  was  changed 
from  the  polished  to  the  undermilled  kind  and  reduced  from  20  to 
16  ounces;  1.6  ounces  of  beans  was  added;  the  meat  allowance 
of  12  ounces  and  other  components  were  left  unchanged.  From  the 
time  this  new  ration  went  into  effect,  in  March,  1910,  beriberi 
rapidly  declined,  and  before  September  had  entirely  disappeared. 

A  certain  amount  of  milling  is  probably  necessary  in  order  to 
remove  the  husk  and  give  the  grain  a  more  acceptable  appearance, 
but  it  should  be  as  slight  as  possible.  A  simple  test  to  ascertain 
the  proportion  of  pericarp  left  is  to  stain  the  grain  with  Gram's 
iodine  solution,  then  wash  and  dry;  the  pericarp  (if  originally 
white)  remains  grayish-white,  while  the  endosperm,  or  parts 
denuded  of  pericarp,  will  become  dark  blue,  almost  black.  Unpol- 
ished rice  contains  about  0.55  per  cent,  of  phosphorus  (as  phos- 
phorus pentoxid,  P0  O5).  It  is  considered  that  a  rice  containing 
at  least  0.4  per  cent,  of  phosphorus  will  not  cause  beriberi,  and  that 
one  with  less  is  unsafe  when  it  forms  the  principal  article  of  diet.  It 
is  not  claimed  that  lack  of  phosphorus  is  the  cause  of  the  disease, 
but  that  its  percentage  is  a  reliable  index  of  the  proportion  of 
pericarp  left,  and  therefore  of  the  beriberi-producing  power  of  a 
given  rice. 

The  "'  cured  rice  "  of  India  and  other  places  is  a  rice  that  has 


Il8  MILITARY    HYGIENE. 

been  parboiled  and  then  dried  before  milling,  with  the  result  that 
the  pericarp  and  aleurone  layer  are  less  easily  and  completely 
removed  from  the  grain.  Beriberi  is  rare  where  cured  rice  is 
commonly  used. 

Although  enough  progress  has  been  made  in  the  etiology  of  this 
disease  to  enable  us  to  prevent  it,  and  eradicate  it  where  it  already 
exists,  we  do  not  know,  as  yet,  the  substance  in  rice  whose  loss  gives 
rise  to  beriberi.  To  begin  with,  it  is  not  a  starvation  disease,  for  it 
may  coexist  with  a  fair  sufficiency  of  food  among  well-to-do  classes. 
When  the  effect  of  a  polished  rice  dietary  was  clearly  understood  it 
was  generally  believed  that  beriberi  was  the  result  of  a  lack  of 
proteid  substance ;  but  inasmuch  as  it  may  develop  with  a  sufficient 
amount  of  nitrogenous  food  this  view  must  be  set  aside.  Thus  it 
prevailed  among  the  Filipino  scouts  in  1908  and  1909  (12  and  10 
per  thounsand  of  admissions)  when  they  were  receiving  a  compara- 
tively generous  ration,  including  12  ounces  of  meat  which,  if  only 
two-thirds  of  it  were  consumed,  should  have  furnished  all  necessary 
nitrogen.  But  they  also  drew  20  ounces  of  rice,  while  much  of  the 
meat  may  have  been  sold  or  otherwise  disposed  of.  However,  it 
should  be  borne  in  mind  that  the  milling  process  removes  less  than 
one-third  of  the  total  nitrogen  of  the  grain.  As  to  the  phosphorus 
and  potassium  removed  with  the  pericarp,  most  investigators  are  of 
opinion  that,  although  useful  constituents,  they  cannot  be  considered 
the  chief  causative  factors. 

Fowls  readily  develop  multiple  neuritis  when  fed  exclusively  on 
polished  rice ;  although  this  polyneuritis  gallinarum  and  beriberi  are 
not  identical,  it  has  been  ascertained  that  the  capacity  of  a  rice  to 
produce  polyneuritis  in  fowls  is  an  accurate  indicator  of  its  beriberi- 
producing  quality.  By  experimenting  on  fowls  Chamberlain  and 
Vedder  found  that  the  constituent  of  rice  polishings  which  will 
prevent  neuritis  is  soluble  in  both  cold  water  and  cold  alcohol. 
These  solvents  take  up  only  1.34  per  cent,  of  the  polishings,  namely, 
sucrose,  nitrogen,  mineral  matters  and  traces  of  phosphorus.  The 
solution  being  dialized,  it  was  found  that  the  diffusate  was  neuritis- 
preventing,  while  the  substances  which  did  not  pass  through  the 
membranes  were  not.  Deducting  all  substances  known  to  be  inac- 
tive, leaves  only  0.4  per  cent,  in  which  must  be  sought  the  neuritis- 
preventing  principle.  From  his  experiments  Vedder  concludes  that 
this  principle  is  not  a  fat,  proteid,  inorganic  salt  or  alkaloid,  but 
probably  an  organic  base  as  claimed  by  Funk. 


PARASITIC   DISEASES. 

In  conclusion,  it  is  established  that  a  dietary  consisting  chiefly  of 
rice  will  produce  beriberi  if  the  grain  is  polished ;  that  it  will  not  do 
so  if  the  grain  be  simply  undermilled ;  that  rice  in  a  varied,  well- 
balanced  ration  is  entirely  harmless,  even  if  polished,  provided  the 
quantity  be  moderate ;  but  that  on  account  of  the  marked  fondness 
shown  for  rice  by  Orientals  and  the  danger  of  their  consuming  it  in 
large  amounts  to  the  exclusion  of  other  foodstuffs,  the  use  of  under- 
milled  grain  should  be  encouraged  and  whenever  possible  enforced 
wherever  beriberi  prevails  or  has  been  endemic. 

It  seems  probable  that  other  cereals  are  like  rice  in  this  respect, 
and  that  when  making  up  the  bulk  of  the  diet  they  must  be  used 
whole,  cortical  layers  as  well  as  starch  cells,  to  prevent  some  form 
of  beriberi.  Thus  Dr.  Little  found  that  the  people  of  Newfound- 
land, when  obliged  to  live  for  long  periods  of  time  on  white  bread 
and  tea,  often  suffer  from  peripheral  neuritis.  This  disorder  disap- 
pears when  the  white  bread,  made  of  fine  white  flour,  is  replaced 
by  bread  made  from  whole-wheat  flour. 

SCURVY. 

Of  diseases  caused  by  scant  and  improper  diet  among  soldiers, 
scurvy  has  been  the  most  common  and  widespread.  It  is  a  disorder 
characterized  by  great  debility,  a  spongy  condition  of  the  gums  and 
a  tendency  to  hemorrhages. 

It  results  from  the  absence  or  insufficiency  of  vegetables  and  fresh 
meats  in  the  food,  causing  a  reduction  of  the  alkalinity  of  the  blood. 
(See  page  349.)  That  vegetables  are  not  essential,  at  least  for  a 
period  of  several  months,  is  shown  by  the  remarkable  experience  of 
the  polar  explorers  Nansen  and  Johansen,  who  subsisted  on  meat 
and  fat  alone  during  their  memorable  winter  in  Franz- Josef  Land, 
and  remained  in  good  health 

This  disease  was  formerly  very  prevalent  among  soldiers  and 
sailors  but,  with  more  varied  and  wholesome  food,  it  has  long  ago 
ceased  to  play  an  important  part  in  the  morbidity  of  camps.  It  is 
still  liable  to  occur  wherever  troops  are  besieged  and  cut  off  from 
fresh  supplies ;  thus,  during  the  Russo-Japanese  War,  the  Russians 
in  Port  Arthur  suffered  severely  from  it.  At  the  time  of  the  sur- 
render of  that  fortress  there  were  9,093  cases  of  scurvy  out  of  a 
total  number  of  11,105  sick. 

The  horrible  ravages  of  scurvy  in  former  times,  even  when  men 
were  fairlv  well  fed,  lead  to  the  belief  that,  under  conditions  of 


I2O  MILITARY    HYGIENE. 

crowding  and  bad  ventilation,  an  infectious  element  becomes  devel- 
oped whereby  its  virulence  is  greatly  increased.  Thus  reliable  wit- 
nesses have  described  epidemics  of  scurvy  which  could  not  be 
controlled  on  board  ship,  but  ceased  as  soon  as  crews  and 
passengers  were  put  ashore,  although  given  the  same  diet  and 
treatment,  showing  the  presence  of  some  secondary  infectious  agent 
clinging  to  the  ship. 

The  proper  treatment  consists  in  a  diet  of  fresh  vegetables 
(especially  raw  potatoes,  tomatoes  and  onions),  milk  and  fresh 
meats,  together  with  plenty  of  pure  air. 

MISCELLANEOUS  DISEASES. 

HEART    DISEASES. 

These  affections  have  always  been  among  the  four  or  five  diseases 
causing  the  highest  rates  of  mortality  and  discharge  among  soldiers. 
For  the  period  1909-1911,  they  caused  a  mean  death  rate,  in  the 
United  States,  of  0.28  per  1,000,  ranging  from  0.31  in  1909  to  0.27 
in  1911;  and  in  the  Philippines,  of  0.39  per  1,000,  ranging  from 
0.61  in  1909  to  0.16  in  1911. 

The  death  rates  for  the  United  States  and  British  armies,  for 
troops  at  home,  are  about  the  same,  but  several  times  greater  than 
for  the  French  and  German  armies.  This  marked  difference  is  diffi- 
cult to  account  for,  inasmuch  as,  in  the  latter  armies,  the  drill,  train- 
ing and  hardships  to  which  the  men  are  subjected  are  probably  more 
arduous  than  in  the  former.  For  lack  of  a  more  convincing  reason 
it  may  be  conjectured  that  these  higher  rates  in  cardiac  diseases  are 
attributable  to  the  corresponding  higher  rates  for  venereal  diseases 
and  alcoholism. 

It  is  natural  to  suppose  that  soldiers  would  be  particularly  liable 
to  heart  disease,  from  tight  fitting  coat,  pressure  of  belts  and  straps, 
weight  of  equipment,  drill,  marching  and  hardships,  to  say  nothing 
of  cigarette  smoking  and  alcoholic  and  venereal  excesses.  But  this 
supposition  is  not  confirmed  by  statistics,  and  any  comparison 
between  military  and  civil  rates  is  rather  to  the  advantage  of  the 
former.  The  exceedingly  low  death  rate  from  cardiac  disease  in 
the  Prussian  Army  (0.02  per  1,000)  tends  to  prove  this.  The  preva- 
lence of  heart  affections  among  young  men  in  civil  life  is  well  shown 
in  the  reports  from  our  recruiting  depots.  DeLoffre  found  that 


PARASITIC   DISEASES.  121 

exactly  100  out  of  1,000  applicants  for  enlistment  at  Columbus  Bar- 
racks suffered  from  some  abnormal  cardiac  condition,  requiring  the 
rejection  of  19.  (See  page  198.)  Of  the  total  number  of  applicants 
rejected  for  the  3  years  1909-1911,  10.6  per  cent,  were  for  heart 
disease,  a  ratio  much  higher  than  for  any  other  class  of  diseases 
except  venereal  diseases  (n.i  per  cent.).  The  ratio  of  rejections 
for  heart  disease  is  likewise  the  highest  in  the  British  Army. 

See  also  under  Recruiting,  and  the  effects  upon  the  heart  of  train- 
ing, marching  and  athletics,  under  Exercise.  For  Irritable  Heart, 
see  page  244. 

TRENCH   FOOT. 

This  condition  is  one  of  the  results  of  the  trench  warfare  so 
characteristic  of  the  present  European  conflict.  Owing  to  the  diffi- 
culty and  often  impossibility  of  draining  trenches,  the  men  are 
frequently  compelled  to  stand  for  hours  in  cold  water  or  mud,  up  to 
or  above  the  ankles.  Stagnant  water  becomes  warmed  to  some 
extent,  but  in  running  water  the  suffering  and  danger  are  much 
greater.  The  factors  of  wetness,  cold  and  tight-fitting  foot  and 
leg  wear  render  the  circulation  sluggish  and  the  skin  liable  to 
infection,  conditions  which  tend  to  the  production  of  extensive  chil- 
blains and  a  type  of  frostbite  which  may  terminate  in  gangrene. 

The  preventive  measures  consist  in  keeping  the  feet  dry  and 
warm.  Rubber  boots  over  woolen  socks  will  do,  but  are  expensive 
and  seldom  available.  A  simple  practical  device  is  to  thoroughly 
grease  the  feet  and  socks.  Still  much  better  is  to  wear  socks  made 
of  thin,  soft  oil-silk,  between  two  ordinary  socks,  the  outer  one  well 
greased. 

ASPHYXIATING  GASES. 

Notwithstanding  the  clause  of  the  Convention  of  Geneva  forbid- 
ding belligerents  "  To  employ  poison  or  poisoned  weapons,"  asphyxi- 
ating gases',  one  of  the  new  and  most  terrible  developments  of  war- 
fare, are  used  on  an  extensive  scale.  We  are,  therefore,  in  presence 
of  a  trauma  rather  than  a  disease.  Chlorine  seems  to  be  the  most 
used,  but  carbon  monoxid,  sulphurous  acid,  formaldehyde,  bromin 
and  hydrocyanic  acid  are  alleged  to  have  been  utilized.  The 
symptoms  are  most  distressing:  gasping  respiration  with  marked 
"  air  hunger,"  sharp  pain  in  the  air  passages  and  extreme  cyanosis. 

The  only  preventive  measure  so  far  found  effective  is  the  wearing 
of  a  mask  or  respirator,  whereby  the  inspired  air  is  made  to  pass 
through  a  preparation  which  neutralizes  the  poisonous  gas. 


CHAPTER  XI. 
DISEASES  CAUSED  BY  IMMORAL  OR  INTEMPERATE  HABITS. 

VENEREAL  DISEASES. 

These  diseases  belong  to  the  group  of  infectious  disorders,  but  it 
is  deemed  best  to  consider  them  by  themselves  under  the  above 
caption. 

They  include  three  distinct  affections,  all  infectious  and  con- 
tagious, namely: 

1.  Gonorrhea,  caused  by  the  gonococcu-s,  a  micro-organism  (diplo- 
coccus)  which  not  only  produces  the  primary  and  direct  lesions  of 
the  genital  tract,  but  may  also  reach  many  other  parts  of  the  body, 
resulting  in  gonorrheal  septicemia,  endocarditis,  arthritis,  myositis, 
ocular  complications,  neuritis,  etc. 

2.  Soft  chancre,  caused  by  the  bacillus  of  Ducrey ;  this  organism 
is  arrested  by  the  inguinal  lymph  glands,  so  that  the  sore  always 
remains  localized. 

3.  Syphilis,   caused  by   a  spirally-curved  organism   or  spirillum 
(Treponema  pallidnm)  which,  at  first  localized  in  a  small,  inactive 
chancre,  soon  invades  the  entire  system,  so  that  there  is  no  organ 
in  the  body  nor  any  tissue  in  the  organ  which  may  not  become 
involved.    Frequently  associated  with  this  organism  is  another  spir- 
illum (Spirochccta  refringens},  larger  and  more  darkly  stained,  but 
bearing  no  causal  relation  to  syphilis. 

Venereal  diseases,  which  always  have  the  highest  rate  of  admis- 
sions in  peace  time,  may  become  less  prevalent  under  the  strenuous 
and  exciting  conditions  of  war.  During  the  Civil  War  and  the 
Spanish-American  War  they  caused  fewer  admissions  ("83  and  82 
per  1,000,  respectively)  than  several  of  the  other  common  camp  dis- 
eases, passing  from  the  first  to  the  fifth  place.  This,  however,  was 
due,  not  so  much  to  an  actual  reduction  of  venereal  diseases  as  to  the 
greatly  increased  rates  of  the  other  diseases. 

In  the  war  fields  of  Europe  (1915  and  1916),  a  decided  increase 
has  been  noted  (from  10  to  16  per  cent,  according  to  Gaucher) 
not  only  in  the  belligerent  armies  but  also  in  the  civilian  population. 

They  are,  by  far,  the  most  important  factor  affecting  the  efficiency 

122 


DISEASES    CAUSED    BY    IMMORAL    OK    INTEMPERATE    HABITS       123 


of  modern  armies  in  peace.  Their  rates  in  the  U.  S.  Army  at  home, 
per  1,000  of  mean  strength,  are  given  in  the  following  statement 
(Report  of  Surg.  Gen.,  1916)  : 


Discharged  on 

Admitted. 

certificate  of 

Died. 

Noneffective. 

disability. 

•a 

•o 
Si 

19 

1 

<S 

i 

T3 

Z 

• 

.t^ 

o 

(Q 

.^ 

c) 

3 

0 

Ii 

.t^ 

o 

"Q 

jC 

"3 

O 

J3 

"o 

€ 

IS 

"o 

3 

JZ 

"o 

f" 

5 

O 

H 

£ 

O 

H 

£ 

O 

H 

P 

O 

Gonorrhea  and  re- 

sults: 

1915  

50.56 

50.91 

41.82 

0.3' 

O.32 

O.O2 

O.O2 

2.05 

2.04 

2.19 

1914  

51-35 

52.04 

28.99 

•  32 

.33 

I  .80 

1.81 

i  .44 

1913  

49.46 

49  .  14 

60.  14 

.66 

.68 

1.84 

i  .84 

I  6s 

1912  

70.07 

69.87 

74-36 

.60 

.61 

0.40 

.02 

.02 

3.26 

3-27 

2.94 

1911  

94-52 

94.48 

45-12 

.79 

.84 

4.68 

4-72 

3-93 

Chancroid: 

1915  

15.80 

15-73 

17.63 

.03 

.02 

.41 

-72 

.71 

.8s 

1914  

19.96 

20.09 

18.56 

.80 

.79 

1.18 

1913  

15.38 

IS." 

24.76 

.57 

•  56 

.98 

1912  

2O.O9 

20.52 

10.45 

.03 

.03 

1.  01 

1.03 

•  50 

1911  

25.04 

25.22 

21.82 

1.32 

1-34 

I.  OS 

Syphilis: 

I9IS  

17.24 

17-44 

12.30 

•  54 

51 

1.23 

.05 

03 

0.41 

1.22 

1.23 

1.18 

1914  

18.53 

18.86 

7.66 

.55 

•  43 

4-38 

.05 

.05 

I.  15 

I.  ii 

2.46 

1913  

2O.99 

20.98 

21  .23 

•  35 

.29 

2.36 

.07 

.05 

•  59 

1.  17 

1  .  15 

i  .90 

1912  

25.58 

25.84 

19.69 

.62 

.61 

.80 

-03 

•  03 

1.70 

1.68 

2.  II 

1911  

44-30 

45-33 

25-91 

.52 

.48 

1.36 

.  II 

.  II 

2.82 

2.8s 

2.3O 

Total  venereal: 

191  5  

83.60 

84.08 

71.75 

.88. 

.85 

i  .64 

.06 

•  OS 

.41 

3-99 

3.98 

4.22 

1914  

89.84 

90.99 

52.52 

.87 

.77 

4.38 

-05 

.05 

i.  IS 

I.  II 

2.46 

1913 

85.83 

85.23 

106.  13 

i  .01 

•  97 

2  .36 

.07 

.05 

•  59 

3.58 

3-55 

4-  S3 

1912  

H5.74 

116.24 

104.50 

1.26 

1.26 

I  .21 

•  05 

.05 

5.96 

5.98 

5.55 

1911  

163.85 

165.03 

142.85 

1.31 

I.3I 

1.36 

.  ii 

.  ii 

8.82 

8.91 

7-29 

It  is  seen  from  the  above  table  that,  as  the  natural  effect  of  the 
prophylactic  measures  urged  and  imposed  upon  enlisted  men,  a 
decided  improvement  in  all  rates  has  taken  place  since  1911. 

In  the  Philippines,  for  1911,  the  admission  rate  was  305.12  and 
for  non-effectiveness  16.63.  For  1915  the  admission  rate  was 
reduced  to  186.32. 

For  the  entire  Army,  at  home  and  in  the  colonies,  for  1911,  the 
total  admission  rate  was  185.13,  and  non-effective  rate  10.14,  corre- 
sponding to  738  men  constantly  sick  and  excused  from  duty  by 
reason  of  venereal  diseases.  For  1914  and  1915  the  non-effective 
rate  was  reduced  to  4.73  and  4.78  respectively  or  less  than  one-half. 

In  the  U.  S.  Navy,  the  rates  do  not  materially  differ  from  those  of 
the  Army.  In  1907,  the  Surgeon  General  reported  that  their  pro- 


124  MILITARY    HYGIENE. 

gressive  increase  "  is  alarming  and  calls  for  the  most  serious  con- 
sideration." The  rates  of  admissions  for  1909-1911  were  199,  196 
and  177,  respectively,  but  have,  since  then,  also  been  substantially 
reduced. 

Comparing  our  rates  with  those  of  foreign  armies,  a  great  differ- 
ence is  apparent.  The  latter,  as  found  in  the  latest  obtainable  data, 
are  as  follows  for  home  troops :  British,  66 ;  Austro-Hungarian, 
54.2;  French,  27.8;  Prussian,  18.7;  Bavarian,  15.2.  In  trying  to 
account  for  this  discrepancy  it  must  be  remembered  that  the  methods 
of  reporting  disease  vary  in  different  armies ;  in  some,  only  patients 
treated  in  hospital  are  accounted  for,  while  in  our  service  all  patients 
excused  from  any  duty,  even  while  in  barracks,  must  be  entered  on 
the  sick  report.  As  regards  venereal  diseases,  our  soldiers,  for 
hygienic  reasons,  are  advised  to  report  to  the  surgeon  as  soon  as 
possible,  without  fear  of  punishment,  and  probably  fewer  fail  to  do 
so  than  in  foreign  armies. 

But  after  making  due  allowance  for  all  those  causes  which  render 
venereal  statistics  so  proverbially  unreliable,  we  must  accept  the  fact 
that,  in  this  class  of  diseases,  our  army  occupies  an  unenviable  pre- 
eminence. Two  general  causes  will  mostly  account  for  this,  and 
they  likewise  apply  mutatis  mutandis  to  the  preeminence  of  the 
British  rates  among  European  armies  before  1915.  i.  The  Ameri- 
can soldiers,  as  volunteers,  receive  a  liberal  pay,  and  financially  are 
much  better  off  than  those  of  other  countries  under  compulsory  mili- 
tary service;  furthermore,  they  are  not  subjected  to  the  same  stren- 
uous work  and  irksome  restraints ;  hence  they  enjoy  greater 
opportunities  and  facilities  for  dissipation.  Let  the  average  soldier, 
from  any  race  or  nation,  be  given  money  and  leisure,  and  abundant 
pleasure  resorts  within  easy  reach,  and  the  inevitable  result,  as 
expressed  in  terms  of  venery  and  alcoholism,  can  be  readily  fore- 
told. 2.  In  continental  Europe,  the  State  realizing  the  gravity  of 
the  ravages  of  venereal  infection  endeavors  to  restrain  prostitution, 
or  mitigate  its  effects,  by  police  regulations  whereby  prostitutes  are 
subjected  to  systematic  registration  and  examination  so  that  all 
found  diseased  may  be  segregated  and  cured.  There  can  be  no 
doubt  that  such  a  system  is  justifiable  on  the  part  of  the  State  on 
the  ground  of  self-defense  against  the  most  widespread  and  loath- 
some of  contagious  diseases,  nor  of  its  great  efficacy  in  checking 
them,  especially  among  soldiers.  But  a  strong  public  sentiment  has 


DISEASES    CAUSED    BY    IMMORAL    OR    INTEMPERATE    HABITS       125 

opposed  this  recognition  and  regulation  of  prostitution  by  the  State 
authorities  in  England  and  America,  with  the  result  that  venereal 
rates  in  both  countries  greatly  exceed  those  of  other  civilized  nations 
where  the  system  is  still  more  or  less  in  vigor. 

It  may  be  argued  that  volunteer  soldiers,  that  is  to  say,  men  who 
freely  enlist  in  time  of  peace,  do  not  usually  come  from  the  more 
industrious  and  sober  classes,  that  they  are  mostly  men  of  unformed 
and  unstable  character  and  habits,  of  neglected  education,  unculti- 
vated moral  sense,  and  who  take  but  little  thought  of  the  conse- 
quences of  their  acts.  But,  on  the  other  hand,  one  must  remember 
that  they  are  sifted  men,  who  have  passed  a  careful  physical  and 
mental  examination,  and  whose  habits  have  been  inquired  into  and 
found  at  least  good.  It  is  doubtful,  therefore,  whether,  if  placed 
tinder  the  same  conditions,  the  proportion  of  our  volunteers  violat- 
ing the  moral  laws  would  be  greater  than  among  the  compulsorily 
enrolled  soldiers  of  European  armies.* 

Diagnosis. —  The  discovery  of  the  causative  organism  of  syphilis 
and  the  elaboration  of  the  Wasserman  reaction  have  rendered  the 
diagnosis  of  this  disease  easier,  more  reliable  and  possible  at  a 
much  earlier  date,  so  that  treatment  can  be  started  before  any 
damage  is  done.  On  the  appearance  of  the  initial  lesion  a  positive 
diagnosis  is  made  by  finding  the  treponema.  The  demonstration  is 
still  more  complete  if  a  positive  Wasserman  reaction  can  be  obtained. 
This  reaction  is  positive  in  more  than  one-fourth  of  the  cases 
during  the  first  week,  and  nearly  in  all  cases  by  the  end  of  the 
fourth  week.  It  may  also  be  positive  in  a  few  other  infections,  but 
in  none  whose  diagnosis  can  be  confused  with  syphilis,  except  per- 
haps yaws.  The  chief  difficulty  lies  in  the  correct  interpretation  of 
negative  results.  Thus  it  is  absent  in  syphilitic  cases  undergoing 
a  course  of  mercurial  or  arsenical  treatment,  or  immediately  after 
such  a  course.  The  Wasserman  reaction  also  enables  the  physician 
to  recognize  latent  syphilis  in  the  absence  of  symptoms,  and  to 
determine  with  exactness  the  time  when  a  patient  may  be  considered 
cured.  By  means  of  it,  Reasoner,  U.  S.  Army,  found  that  5  per  cent, 
of  the  enlisted  personnel  at  his  post  gave  evidence  of  syphilitic 
lesions.  The  medical  examiners  at  Fort  Slocum  (Mil.  Surg.,  June, 

*  Note. —  Inasmuch  as  a  large  American  drafted  army  is  soon  to  be  mobil- 
ized in  training  camps,  and  later  proceed  to  the  battlefields  of  Europe,  we 
shall  probably  obtain  data  that  will  throw  further  light  upon  this  subject. 


126  MILITARY    HYGIENE. 

1911)  found  that  46.1  per  cent,  of  all  men  discharged  on  certificate 
of  disability  gave  a  positive  reaction. 

Thus  has  also  been  ascertained  that  gangosa,  a  disease  of  the 
Pacific  Islands  causing  serious  disfigurement  of  the  nose  and  adjoin- 
ing regions,  is  a  form  of  tertiary  syphilis. 

The  luetin  test  is  of  most  value  in  the  latent  and  tertiary  stages, 
when  the  Wasserman  reaction  becomes  less  reliable.  It  sometimes 
happens  that  in  cases  in  which  the  Wasserman  reaction  has  been 
negative  for  one  or  two  years,  the  luetin  test  or  the  provocative 
Wasserman  test  will  still  demonstrate  the  presence  of  the  disease. 

The  standard  of  cure  in  the  Army  is  thus  formulated  by  Nichols : 
"  One  year  without  treatment,  without  any  suspicious  clinical  signs, 
with  several  negative  Wasserman  reactions  and  no  positive  ones, 
and  with  a  negative  provocative  Wasserman  reaction  and  luetin 
test  at  the  end  of  the  year." 

PROPHYLAXIS. — Outside  of  purely  moral  teaching,  which  must  ever 
remain  the  fundamental  basis  of  all  sound  home  and  school  educa- 
tion, the  most  fruitful  prophylactic  measures  may  be  considered, 
seriatim,  as  follows : 

i.  Soldiers  should  be  taught  all  knowledge  deemed  necessary  and 
useful  on  the  subject.  For  instance,  that  sexual  intercourse  is  not 
necessary  for  the  attainment  of  the  best  physical  and  mental  health, 
and  that  a  strong,  manly  character  is  developed  only  by  self-control 
and  continence.  They  should  have  a  proper  appreciation  of  the 
prevalence  and  gravity  of  venereal  diseases.  Thus  it  is  estimated 
that  fully  one-third  of  all  prostitutes  are  suffering  from  some  form 
of  them  in  an  infectious  stage.  According  to  Leser,  33  per  cent,  of 
all  syphilitics  eventually  die  of  tuberculosis,  paralysis  or  aortic 
aneurism.  The  sinister  predilection  of  tertiary  syphilis  for  the  ner- 
vous system  is  well  known.  All  deaths  from  general  paralysis  and 
locomotor  ataxia,  as  well  as  half  of  those  from  paraplegia  and 
softening  of  the  brain,  are  attributable  to  syphilis. 

Many  men  expose  themselves  thoughtlessly,  with  the  impression 
that,  at  the  worst,  a  few  days  in  hospital  will  suffice  to  get  rid  of  the 
consequences.  This  is  foolish  and  dangerous  ignorance  which 
officers,  especially  medical  officers,  should  endeavor  to  dispel  by  a 
few  plain  talks,  demonstrating  to  them  the  many  complications  and 
sequels  of  gonorrhea  as  well  as  the  ravages  of  syphilis  which  affect 
not  only  the  incontinent  but,  through  matrimony,  many  innocent 


DISEASES    CAUSED    BY    IMMORAL    OR    INTEMPERATE    HABITS       I2/ 

women  and  children.  Let  them  know  that,  in  the  opinion  of  gyne- 
cologists, a  majority  of  the  hazardous  surgical  operations  performed 
upon  married  women  are  made  necessary  in  consequence  of  gonor- 
rheal  infection  by  the  husband;  and  another  terrifying  fact,  that 
syphilis,  so  far  as  absolutely  known,  is  not  only  directly  transmitted 
from  father  to  children,  but  the  sole  disease  thus  transmitted,  as  it 
were  a  special  curse  upon  the  human  race. 

All  this  knowledge  should  be  particularly  imparted  to  recruits, 
for  it  is  a  matter  of  record  that  they  are  much  more  prone  to  expose 
themselves  and  contract  venereal  infections  than  trained  soldiers. 

2.  All  efforts  to  abolish  prostitution  have  been  futile ;  universal 
experience  has  shown  that  it  is  an  inevitable ,. social  evil;  but  that  if 
it  cannot  be  prevented,  its  effects  can  certainly  be  mitigated  and 
reduced  to  a  minimum  by  suitable  regulations.     It  has  been  found 
that  at  a  certain  number  of  posts,  at  home  and  in  our  colonies,  the 
civil  authorities  have  cooperated  with  commanding  officers  in  exer- 
cising sanitary  supervision  over  prostitutes.    It  is  believed  that  such 
cooperation,  wherever  it  can  be  secured,  will  always  result  in  a 
marked  decrease  of  venereal  rates. 

In  war  the  conditions  are  different,  and  the  strong  hand  of  mili- 
tary power  can  be  exerted  to  protect  camps  and  garrisoned  cities 
from  the  worst  evils  of  prostitution.  It  is  even  reasonable  to  sup- 
pose that,  under  such  circumstances,  the  civil  authorities  will  will- 
ingly lend  their  assistance.  The  registration  and  inspection  of 
prostitutes,  as  a  measure  of  military  necessity,  was  done  with  great 
success  at  Nashville  and  Memphis,  Tenn.,  during  the  Civil  War,  so 
that  there  are  excellent  precedents  for  it. 

3.  The  life  of  the  soldier  in  garrison  and  camp  should  be  made  as 
attractive  as  possible,  so  that  he  may  not  so  readily  succumb  to  the 
allurements  of  the  outside  dens  that  lay  their  snares  for  him.    The 
post  exchange  should  have  all  its  recreation  features  fully  devel- 
oped, such  as  reading-room,  card  and  billiard  rooms,  lunch  room, 
gymnasium   and   bowling-alley.  v  The    restoration    of   the   canteen 
feature,  with  the  regulated  sale  of  beer  and  other  mild  spirituous 
refreshments,  would  probably  do  more  to  keep  the  men  at  home  and 
away  from  the  haunts  of  vice  than  any  other  preventive  measure. 
The  establishment  of  soldiers'  clubs,  independently  of  the  post  ex- 
change, has  also  been  strongly  recommended. 

4.  The  systematic  physical  inspection  of  the  men  is  of  undoubted 


128  MILITARY    HYGIENE. 

value,  not  only  in  discovering  neglected  and  unreported  cases,  but 
also  in  prompting  them  to  submit  to  treatment  as  soon  as  the  disease 
manifests  itself.  Under  G.  O.  No.  17,  1912:  "  Commanding  officers 
will  require  a  medical  officer,  accompanied  by  the  company  or  de- 
tachment commander,  to  make  a  thorough  physical  inspection  twice 
in  each  month  of  all  enlisted  men  (except  married  men  of  good 
character)  of  each  organization  belonging  to  or  attached  to  the 
command.  These  inspections  will  be  made  at  times  not  known 
beforehand  to  the  men  and  preferably  immediately  after  a  forma- 
tion. The  dates  on  which  the  physical  inspections  of  the  various 
organizations  are  made  will  be  noted  on  the  monthly  sanitary 
reports." 

"  At  these  inspections  a  careful  examination  of  the  feet  and  foot- 
wear, and  of  the  condition  of  personal  cleanliness  of  the  men  will 
be  made,  as  well  as  a  careful  observation  for  the  detection  of 
venereal  diseases." 

Men  found  suffering  from  venereal  disease  are  to  be  subjected  to 
treatment  and  strictly  confined  to  the  limits  of  the  post. 

5.  It  is  essential  that  men  contracting  any  form  of  disease  after 
sexual  intercourse  should  report  at  the  hospital  as  soon  as  the  first 
symptoms  manifest  themselves,  for  examination  and  treatment,  so 
that  the  infection  may  be  attacked  when  most  curable  and  before 
complications  arise.    As  part  of  the  treatment,  each  man  should  be 
furnished  with  a  printed  leaflet  telling  him  clearly  what  to  do  and 
what  to  avoid  to  cure  himself  and  prevent  the  contamination  of  his 
comrades.    While  under  treatment,  or  at  least  as  long  as  the  disease 
remains  in  an  infective  stage,  he  should  be  confined  to  the  limits 
of  the  hospital. 

6.  The  venereal  register  kept  at  all  post  hospitals,  as  prescribed 
by  the  Surgeon  General,  is  an  excellent  means  of  control  whereby  a 
man,  once  admitted  to  treatment,  is  kept  under  continuous  observa- 
tion until  cured.     Should  he  be  transferred  while  under  treatment, 
his  venereal  history  is  transmitted,  together  with  other  pertinent 
details,  to  the  medical  officer  who  is  to  have  future  charge  of  the 
case. 

7.  The  question  of  personal  prophylaxis,  that  is  to  say,  of  the 
employment  of  disinfectant  applications  to  prevent  infection  after 
sexual  intercourse,  has  been  much  discussed  from  the  moral  and 
sanitary  points  of  view.  There  is  now  a  general  consensus  of  pro- 


DISEASES    CAUSED    BY    IMMORAL    OR    INTEMPERATE    HABITS       I2Q 

fessional  opinion,  in  this  country  and  Europe,  that  such  prophylaxis 
is  not  only  justifiable  but  desirable.  There  is  no  good  reason  why 
a  man  who  lacks  the  necessary  moral  stamina  to  control  his  sexual 
appetite  should  not,  at  least,  try  to  prevent  the  possible  danger  of  a 
physical  disability  which  "  unfits  him  for  the  performance  of  his 
duty  as  a  soldier  and  seriously  impairs  his  usefulness  as  a  citizen." 
(Rep.  Surg.  Gen.}  The  contention  that  the  application  of  a  disin- 
fectant removes  the  fear  of  contracting  venereal  infection,  and  is  an 
incitement  to  licentiousness  by  making  it  safe,  has  been  disproved 
by  actual  observation.  It  is  notorious  that  the  influence  of  fear  is  a 
deterrent  factor  of  slight  importance.  On  the  contrary,  it  has  been 
remarked  that  the  prominence  given  to  venereal  diseases  by  instruc- 
tion and  the  application  of  personal  prophylaxis,  brings  the  better 
class  of  men  to  a  greater  realization  of  the  enormity  of  the  evils 
likely  to  result  from  exposure 

Medical  officers  are  unanimous  in  their  belief  that  at  least  90  per 
cent,  of  venereal  cases  can  be  prevented  by  the  proper  application  of 
a  suitable  disinfectant  within  a  few  hours  after  exposure. 

G.  O.  17,  1912,  directs  that  "  Commanding  officers  will  require 
that  men  who  expose  themselves  to  the  danger  of  contracting 
venereal  disease  shall  at  once,  upon  their  return  to  camp  or  garri- 
son, report  to  the  hospital  or  dispensary  for  the  application  of  such 
cleansing  and  prophylaxis  as  may  be  prescribed  by  the  Surgeon 
General.  Any  soldier  who  fails  to  comply  with  these  instructions, 
if  found  to  be  suffering  from  a  venereal  affection,  shall  be  brought 
to  trial  by  court-martial  for  neglect  of  duty." 

The  regulations  prescribed  by  the  Surgeon  General,  under  this 
order,  are  briefly  as  follows : 

A  suitable,  easily  accessible  room  is  set  apart  for  the  purpose  and 
placed  in  charge  of  a  properly  instructed  hospital-corps  man,  who  is 
on  duty  or  within  call  at  all  times,  and  to  whom  the  men  report  for 
treatment. 

The  genital  organs  are  thoroughly  washed  with  soap  and  warm 
water.  An  injection  is  made  into  the  urethra  of  4  c.  c.  of  the  stand- 
ard solution  of  2  per  cent,  protargol  dissolved  in  glycerine  (15 
parts)  and  water  (85  parts).  This  should  be  retained  in  the  urethra 
for  three  minutes.  In  individual  cases,  when  the  protargol  solution 
is  found  to  produce  an  irritating  effect,  a  20  per  cent,  solution  of 
argyrol  may  be  used.  The  entire  penis  is  rubbed  with  calomel 


130  MILITARY    HYGIENE. 

ointment  (30  per  cent,  in  benzoated  lard),  care  being  taken  that  the 
folds  of  the  prepuce  and  about  the  frenum  are  thoroughly  covered. 
The  parts  are  then  wrapped  in  a  napkin  of  soft  paper  furnished  for 
the  purpose  in  order  to  protect  the  clothing.  Medical  officers  who 
deem  it  necessary  to  use  other  preparations  than  those  above  speci- 
fied are  required  to  report  the  reasons  for  their  departure  from  the 
usual  treatment. 

In  view  of  the  fact  that  the  hospital  method  described  above  is 
not  applicable  to  soldiers  on  pass  or  furlough  of  more  than  24  hours, 
it  is  recommended  that  protective  packets  be  kept  on  hand  for  sale 
at  post  exchanges.  Men  should  be  advised  to  provide  themselves 
with  these  packets  before  leaving  camp  or  garrison,  for  self-treat- 
ment as  soon  as  possible  after  exposure,  if  they  do  not  intend  to 
return  within  a  few  hours  thereafter.  In  such  cases  the  medical 
officers,  if  satisfied  that  the  packet  has  been  properly  applied,  may 
omit  the  hospital  treatment. 

Several  types  of  prophylactic  packets  or  tubes  are  being  success- 
fully used.  The  Slee  tube  is  a  two-compartment  tube,  with  a  33 
per  cent,  calomel  ointment  in  one  compartment  and  a  20  per  cent, 
argyrol  (or  2  per  cent,  portargol)  solution  in  the  other;  the  solu- 
tion is  injected  into  the  urethra  and  the  ointment  rubbed  on  the 
outside. 

Later  investigations  have  demonstrated  that  calomel  ointment  will 
not  only  prevent  chancre  and  chancroid,  but  that,  when  injected  into 
the  urethra,  it  will  also  kill  gonococci  and  prevent  gonorrhea,  so  that 
argyrol  and  protargol  can  be  dispensed  with  and  the  process  simpli- 
fied.* The  so-called  "  A  and  N  packet  "  has  been  found  very  effi- 
cient in  a  series  of  laboratory  experiments ;  it  consists  of : 
Camphor,  3  per  cent. 

Phenol,  3     "       " 

Calomel,  25     "       " 

Lanoline,  34     "       " 

Benzoated  lard,  35     "       " 

The  same  constituents,  but  without  camphor  and  lard,  were  found 
much  less  efficient  against  gonococci,  showing  the  essential  part 
played  by  these  latter  substances  in  securing  a  diffusible  mixture  and 
close  contact  of  the  active  ingredients  with  the  mucous  surfaces. 

*  The  Military  Surgeon,  Sept.  and  Dec.,  1910.  Col.  L.  M.  Maus,  U.  S. 
Army. 


DISEASES    CAUSED    BY    IMMORAL    OR    INTEMPERATE    HABITS       I$l 

Of  the  contents  of  this  packet  a  small  quantity  is  injected  into  the 
urethra  and  the  remainder  rubbed  on  the  glans  and  prepuce. 

8.  Stoppage  of  pay  while  on  sick  report  for  venereal  disease,  as 
provided  by  law,f  is  just  and  logical  punishment  for  a  soldier  who, 
in  spite  of  frequent  admonitions,  deliberately  exposes  himself  to 
venereal  contagion  and  then  neglects  the  use  of  the  prophylactic 
measure  which  is  almost  certain  to  save  him  from  the  physical  con- 
sequence of  his  act.  Not  only  does  the  government  lose  the  benefit 
of  his  services,  but  is  put  to  greater  expense  on  his  account,  while 
his  comrades  are  obliged  to  perform  his  duties  in  addition  to  their 
own.  It  has  also  been  observed  that  some  men  of  indolent  and 
vicious  nature  expose  themselves  purposely  with  women  known  to 
be  infected  in  order  to  secure  hospital  treatment  and  get  released 
from  irksome  duties.  Many  men  turn  a  deaf  ear  to  the  promptings 
of  their  moral  sense,  but  few  are  insensible  to  a  loss  of  pay.  and 
no  form  of  punishment  could  have  a  greater  deterrent  effect.  It 
will  make  offenders  particularly  careful  to  have  recourse  to  prophy- 
lactic treatment  and  thus  greatly  reduce  their  chances  of  infection. 

ALCOHOLISM. 

(See  Alcoholic  Beverages,  page  414.) 

Alcoholism  and  its  immediate  results,  in  the  U.  S.  Army,  in- 
creased steadily  from  1900  to  1907.  From  the  latter  date  it  has 
constantly  diminished,  so  that  the  admission  rate  of  1911  was  only 
20.31  and  for  1915,  13.87  per  1,000  of  strength,  the  latter  rate  being 
the  lowest  for  any  year  since  1870.  In  the  Philippines,  the  admis- 
sion rate  for  1911  was  28.50  and  the  non-effective  0.43,  practically 
the  same  as  for  1910.  For  1915,  the  admission  rate  is  only  12.0 
and  the  non-effective  0.14. 

For  alcoholism,  even  more  than  for  venereal  diseases,  statistics 
of  admissions  are  quite  valueless  for  purposes  of  comparison.  In 
foreign  armies  drunken  men  are  kept  in  the  guard-house  until  again 
fit  for  duty,  and  seldom  made  a  matter  of  record,  as  in  our  service. 
Statistics  of  mortality,  although  not  entirely  reliable,  are  more  useful 

t  The  following  clause  of  an  act  making  appropriation  for  the  support  of 
the  Army  for  the  year  ending  June  30,  1913: 

"  Provided  that  no  officer  or  enlisted  man  in  active  service,  who  shall  be 
absent  from  duty  on  account  of  disease  resulting  from  his  own  intemperate 
use  of  drugs,  or  alcoholic  liquors,  or  other  misconduct,  shall  receive  pay  for 
the  period  of  such  absence." 


132  MILITARY    HYGIENE. 

as  a  basis  for  comparison.  For  "  acute  alcoholism  "  the  death  rate 
for  our  Army,  at  home,  was  o.ii  in  1910,  0.04  in  1911  and  0.06  in 
1915 ;  for  the  British  Army,  0.03  in  1910 ;  and  for  the  French,  o.ooi 
in  1909.  There  is  no  doubt  that,  in  alcoholic  intemperance,  our 
Army  still  occupies  an  unenviable  high  standing. 

The  reasons  already  given  for  the  prevalence  of  venereal  dis- 
eases in  our  army  will  also  explain  this  high  standing  in  alcoholism. 
Both  forms  of  vice,  alcoholic  intemperance  and  sexual  debauchery, 
are  always  closely  associated,  one  leading  to  the  other,  so  that  the 
soldier  who  frequents  the  saloon  falls  an  easy  prey  to  the  prostitute. 
It  is  the  conviction  of  most  officers  that  the  abolition  of  the  canteen, 
that  is  to  say,  the  prohibition  to  sell  any  kind  of  alcoholic  beverage, 
however  mild,  on  military  reservations,  has  maintained  the  rates  of 
alcoholism  and  venereal  diseases  at  an  unnecessarily  high  level. 
Most  soldiers,  at  the  time  they  enlist,  have  formed  the  habit  to 
indulge  moderately,  whenever  so  inclined,  in  beer  or  other  spirituous 
refreshment.  The  fact  of  becoming  soldiers  cannot  be  expected  to 
render  them  totally  abstinent.  Formerly  they  could  get  beer  and 
other  mild  beverages  at  the  canteen  to  any  reasonable  extent  and 
always  under  official  supervision.  This  feature  of  the  canteen  being 
abolished,  the  men  now  seek  their  alcoholic  refreshments  outside, 
away  from  supervision  and  restraint,  where,  for  the  weak,  there 
is  every  inducement  to  drunkenness.  Its  restoration  has  been 
strongly  urged  by  the  War  Department  and  recommended  to  Con- 
gress in  Presidential  messages. 


CHAPTER  XII. 
THE  TOBACCO  AND  DRUG  HABITS. 

TOBACCO. 

Tobacco  is  the  dried  leaves  of  Nicotiana  tabacum,  indigenous  to 
tropical  America  and  now  cultivated  in  all  warm  and  temperate 
climates. 

Its  principal  constituents  are :  nicotine,  an  alkaloid ;  nicotianin, 
a  solid,  camphor-like  body  to  which  its  odor  is  chiefly  due ;  traces  of 
hydrocyanic  acid ;  various  irritant  aldehydes,  particularly  furfural ; 
a  minute  quantity  of  essential  oil  which  causes  its  flavor ;  about  25 
per  cent,  of  albuminoids ;  a  high  proportion  of  malic,  citric  and  other 
organic  acids ;  a  little  sugar,  and  a  large  amount  of  salts,  yielding 
15  to  20  per  cent,  of  ash. 

Tobacco  smoke  contains:  vapor  of  water,  free  carbon  (in  minute 
particles),  ammonia  compounds,  carbon  monoxid  and  dioxid,  nico- 
tine, prussic  acid  and  furfural. 

Nicotine,  generally  considered  the  active  principle  of  tobacco,  is 
a  volatile  liquid  alkaloid,  very  soluble  in  water  and  virulently  poison- 
ous, standing  next  to  prussic  acid  in  the  rapidity  and  energy  of  its 
toxic  action.  Tobacco  may  yield  as  much  as  7  or  8  per  cent,  of  this 
alkaloid,  but  seldom  contains  more  than  3,  the  average  (as  con- 
sumed) being  less  than  2  per  cent. ;  thus  Havana  cigars  seldom 
exceed  i  per  cent.  Nicotine  is  colorless  in  its  pure  state,  but 
rapidly  turns  brown  on  exposure,  when  part  of  it  is  transformed 
into  an  allied  substance,  pyridine,  having  practically  the  same  prop- 
erties. The  amount  of  hydrocyanic  acid  in  tobacco  smoke,  when 
present  at  all,  is  too  minute  to  have  any  importance  in  this  connec- 
tion. More  suspicious  is  the  aldehyde  furfural,  a  highly  poisonous 
volatile  oil  which,  according  to  the  investigations  of  the  London 
Lancet*-  may  prove  to  be  the  most  injurious  factor  in  smoking.  It 
is  commonly  present  in  the  smoke  of  cheap  Virginia  cigarettes.  To 
it,  by  many,  are  also  attributed  the  toxic  effects  of  cheap  liquors. 

The  primary  effects  of  tobacco  in  those  not  yet  habituated  to  its 
use  are  well  known:  giddiness,  nausea,  vomiting,  diarrhea,  faint- 
ness  and  extreme .  prostration  with  complete  muscular  relaxation. 

*The  toxic,  factor  in  tobacco,  1912.     I,  994  and  II,  547. 

133 


134  MILITARY    HYGIENE. 

If  used  in  increasing  quantities  it  produces  cold  perspiration,  dilated 
pupils,  very  slow  and  intermittent  pulse,  spasms,  laborious  and 
oppressed  breathing,  great  numbness  as  well  as  impaired  power  of 
the  limbs,  and  sometimes  heart  failure,  although  death,  when  it 
occurs,  usually  results  from  paralysis  of  the  respiratory  muscles. 
These  symptoms  show  that  nicotine  acts  primarily  upon  the  spinal 
and  sympathetic  nervous  centers,  and  only  secondarily  upon  the 
brain. 

As  in  the  case  of  other  narcotics,  a  stage  of  comparative  toleration 
is  reached  by  most  people,  after  which  tobacco  may  be  used  with 
apparent  immunity.  The  degree  of  susceptibility  varies  greatly ;  a 
certain  percentage  of  men,  although  in  perfect  health,  have  such 
an  idiosyncrasy  in  regard  to  tobacco  that,  in  spite  of  repeated  efforts, 
they  never  acquire  toleration,  and  therefore  never  develop  the 
smoking  or  chewing  habit ;  others  are  never  able  to  exceed  a  very 
moderate  indulgence  without  suffering  from  gastric  disturbance  and 
nervousness. 

The  advantages  claimed  for  tobacco,  when  used  in  moderation,  are 
that  it  gives  one  something  to  do  when  bored,  that  it  has  a  calming 
and  soothing  effect  on  the  worried  mind,  aids  digestion  after  meal, 
conserves  strength  when  food  is  scant,  and  blunts  the  edge  of  hard- 
ship. It  has  been  observed  that  the  first  effect  of  tobacco  is  to 
produce  a  slight  vaso-motor  constriction  of  blood-vessels  with 
attendant  increase  of  blood  pressure ;  in  other  words,  to  stimulate 
the  circulation.  This  explains  the  cheering  effect  of  a  smoke  upon 
the  exhausted  athlete  after  a  hard  contest,  or  upon  the  hard- 
marching  soldier  after  reaching  camp.  In  view  of  the  universal 
use  of  tobacco  and  from  the  result  of  daily  observation,  it  seems 
safe  to  say  that  in  the  case  of  men  who,  having  reached  their  full 
physical  development,  readily  acquire  the  stage  of  toleration,  and 
indulge  in  smoking  or  chewing  with  discretion  and  moderation,  the 
injurious  effect  of  tobacco  is  probably  a  negligible  quantity. 

It  is  impossible  to  believe,  however,  that  the  habitual  and  constant 
use  of  such  a  virulent  poison  as  nicotine  can  ever  be  of  any  real 
benefit  to  the  system.  All  that  can  be  claimed  for  tobacco  is  that, 
under  the  circumstances  just  mentioned,  it  may  be  practically  harm- 
less. It  should  be  stated  that  most  authorities  on  the  subject  are 
inclined  to  believe  that  the  habit  of  smoking,  persistently  indulged 
in,  is  a  form  of  slow,  insidious  chronic  poisoning,  detrimental  to 


THE   TOBACCO    AND  DRUG    HABIT.  135 

health  at  all  times,  and  that  although  a  period  of  years  may  elapse 
during  which  the  smoker  enjoys  apparent  immunity,  a  day  of  reck- 
oning is  almost  sure  to  come  after  middle  life  when  the  deteriorated 
nerve-cells  are  unable  to  furnish  sufficient  energy  for  the  proper 
functioning  of  the  bodily  organs.  It  is  true  that  sometimes  hard 
smokers  are  also  men  of  strong  physique,  great  energy  and  high 
mental  attainments,  but  it  must  be  remembered  that  only  men  of 
naturally  strong  constitution  are  capable  of  acquiring  the  tobacco 
habit  with  apparent  immunity,  and  that  their  physical  and  mental 
output  is  more  likely  to  be  in  spite,  than  on  account  of  the  habit,  and 
would  probably  have  been  still  greater  and  of  finer  quality  had  they 
been  entirely  free  from  the  effects  of  chronic  nicotine  poisoning. 

It  may  seem  surprising  that  in  view  of  the  camparatively  large 
amount  of  nicotine  present  in  tobacco,  smoking  and  chewing  should 
not  be  more  immediately  injurious.  This  is  explained  by  the  fact 
that  only  a  very  small  proportion  is  absorbed,  most  of  it  being 
burned  in  smoking,  stored  in  the  bowl  of  the  pipe  or  the  stump  of 
the  cigar,  or  ejected  with  the  expectoration  in  chewing. 

Tobacco,  in  a  general  way,  but  particularly  in  youth,  interferes 
with  metabolism,  therefore  with  the  normal  growth  and  repair  of 
tissues,  thus  lowering  physical  and  mental  vigor,  endurance  to 
fatigue  and  resistance  to  disease.  That,  in  young  men,  it  checks  the 
height  and  weight  of  the  body  and  chest  development  has  been  well 
established.  That  it  also  checks  their  mental  development  is  the 
consensus  of  opinion  of  hygienists,  thus  fairly  stated  by  Dr.  G.  L. 
Meylan  of  Columbia  University :  "  It  is  generally  conceded  that  the 
use  of  tobacco  by  college  students  is  closely  associated  writh  idleness, 
lack  of  ambition,  lack  of  application  and  low  scholarship,  though 
these  may  not  be  due  entirely  to  the  tobacco."  It  is  also  notorious 
that  the  use  of  tobacco  predisposes  to  worse  habits.  A  young  man 
always  starts  smoking  before  he  starts  drinking.  Tobacco  by  its 
sedative  effect  makes  him  feel  a  craving  for  alcoholic  stimulation ; 
thus  the  two  habits  are  nearly  constantly  associated. 

The  tobacco  habit,  like  the  opium  habit,  once  developed  becomes 
tyrannical  and  demands  to  be  satisfied.  It  produces  a  craving 
which  unfits  its  victims  for  work  or  enjoyment  until  gratified,  and 
this  gratification  often  leads  them  to  sacrifice  many  of  the  proprieties 
and  amenities  of  life. 

Chewing  is  less  deleterious  than  smoking,  the  tobacco  juice  com- 


136  MILITARY    HYGIENE. 

ing  in  contact  only  with  the  mucous  membrane  of  the  mouth,  whereas 
smoke  reaches  a  much  larger  area  of  absorbent  surface ;  furthermore 
it  is  probable  that  nicotine  volatilized  in  the  smoke  is  more  readily 
absorbed  than  in  liquid  form.  Tobacco  chewing,  however,  con- 
sidered simply  from  the  esthetic  point  of  view,  is  a  most  repugnant 
habit  which  no  well-bred  man  should  cultivate  and  inflict  on  his 
associates. 

From  what  has  been  said  it  is  rational  to  conclude  that  the  use 
of  tobacco  in  any  form  by  students  in  all  educational  establishments, 
including  the  Military  and  Naval  Academies,  should  be  absolutely 
prohibited.  The  development  and  strengthening  of  the  degree  of 
manly  self-control  necessary  to  comply  with  such  prohibition  would 
not  be  the  least  of  the  benefits  conferred  by  such  establishments. 

Local  and  special  effects. —  Smoking  and  chewing  often  cause 
irritation  and  congestion  of  the  mucous  membrane  of  the  mouth 
and  pharynx.  The  catarrhal  condition  of  the  throat  and  hoarseness 
of  the  smoker  is  commonly  observed.  The  saliva  secretion  is 
excessive  and  its  digestive  quality  more  or  less  impaired. 

The  heart  is  readily  affected  by  tobacco,  especially  in  young  men. 
The  so-called  tobacco  heart,  with  rapid,  irregular  or  intermittent 
beat,  is  one  of  the  usual  manifestations  of  hard  smoking.  Many 
candidates  for  the  Military  and  Naval  Academies,  as  well  as  for 
enlistment  in  the  Army  and  Navy,  are  rejected  on  account  of  it. 
Every  athlete  knows  that  smoking  "  hurts  the  wind,"  that  is,  the 
ability  of  the  heart  to  respond  quickly  to  extra  work. 

The  optic  nerve  is  also  specially  liable  to  the  injurious  influence 
of  nicotine ;  the  vision  becomes  weak  and  blurred,  with  floating 
spots,  and  complete  amaurosis  may  follow. 

One  of  the  most  common  effects  of  smoking  is  degeneration  of 
the  motor  nerves,  with  consequent  impairment  of  muscular  control ; 
the  result  is  tremulousness  of  the  hands  and  inability  to  perform 
delicate  movements  requiring  nice  coordination.  Students  addicted 
to  smoking  are  recognjzed  by  their  unsteady  hands  and  inability 
to  draw  a  clean,  straight  line.  This  tremulousness  is  of  course 
much  aggravated  when  the  habit  of  drinking  is  superadded.  Inas- 
much as  the  chief  requirement  of  a  soldier  is  that  he  should  be 
a  good  shot,  it  follows  that  tobacco  which  affects  the  precision  of 
eye  and  hand  must  necessarily  greatly  impair  his  efficiency. 

Pipe,  cigar  and  cigarette. —  Tobacco  smoke,  as  above  mentioned, 


THE    TOBACCO    AND   DRUG    HABIT.  137 

contains  several  deadly  poisons,  nicotine  which  is  volatilized  by  the 
heat,  carbon  monoxid  and  furfural.  Carbon  monoxid,  the  danger- 
ous constituent  of  coal  gas  probably  plays  only  a  minor  part  in  the 
toxic  effect  of  tobacco  smoke ;  furfural  is  still  under  investigation 
and  may  be  shown  to  be  a  much  more  serious  factor;  as  matters 
stand,  nicotine  must  still  be  considered  the  chief  offender. 

Most  of  the  nicotine  is  destroyed  in  the  burning  of  the  tobacco, 
and  only  a  relatively  small  proportion  is  drawn  in  with  the  smoke ; 
the  greater  the  access  of  air  to  the  tobacco  the  more  complete  is  its 
combustion  and  the  more  nicotine  is  destroyed. 

According  to  careful  experiments  recorded  by  the  London  Lancet, 
Virginian  cigarettes,  with  a  nicotine  value  of  1.40  per  cent.,  gave 
up  only  12  per  cent,  (of  the  total  nicotine)  to  the  smoke.  When, 
however,  the  tobacco  of  these  cigarettes  was  smoked  in  a  pipe, 
53  per  cent,  of  the  nicotine  came  out  with  the  smoke.  Havana 
cigars,  with  nicotine  value  of  0.64  per  cent.,  gave  up  to  the  smoke 
31  per  cent.,  while  with  a  British  cigar  containing  1.24  per  cent,  of 
nicotine  the  proportion  in  the  smoke  was  83  per  cent.  From  these 
observations  it  follows  that  the  smoke  of  cigarettes  contains  much 
less  nicotine  than  that  of  pipe  or  cigar.  This  is  due  to  the  fact  that, 
in  cigarettes,  the  tobacco  is  generally  drier  and  better  aerated,  so 
that  its  combustion  is  more  complete  than  in  pipe  or  cigar.  For 
the  same  reason,  cigarette  smoke  contains  less  of  carbon  monoxid 
and  other  products  of  combustion,  and  is  less  irritating. 

Notwithstanding  all  this,  it  is  very  doubtful  whether  cigarettes 
should  be  commended  and  preferred  to  other  forms  of  smoking. 
On  account  of  their  cheapness,  convenience  and  quick  combustion, 
the  smoker  is  but  too  prone  to  develop  a  peculiar  craving  and  mus- 
cular unrest  only  satisfied  by  a  constant  succession  of  them,  so  that, 
in  the  end,  more  tobacco  is  consumed.  However,  the  chief  objec- 
tion to  the  cigarette  is  that  the  smoke,  being  less  irritating  than  that 
of  the  pipe  or  cigar,  is  almost  always  inhaled,  that  is,  drawn  into 
the  larynx  and  the  bronchial  tubes,  and  therefore  exposed  to  a  much 
greater  area  of  mucous  membrane  for  the  absorption  of  toxic 
substances. 

Between  the  pipe  and  cigar  there  is  but  little  choice.  In  both, 
the  smoke  is  more  or  less  charged  with  various  irritant  products  of 
combustion.  The  pipe  is  said  to  yield  more  nicotine  than  the  cigar 
and,  to  that  extent,  to  be  more  objectionable.  The  cigar  is  much 


138  MILITARY    HYGIENE. 

less  harmful  if  a  holder  is  used,  and  if  thrown  away  when  but  little 
more  than  half  consumed,  that  is,  before  the  products  of  combustion, 
through  which  the  smoke  must  pass,  accumulate  in  the  stump. 

THE  MORPHINE  AND  COCAINE  HABITS. 

Morphine  is  the  principal  alkaloid  of  opium,  the  exhudation  ob- 
tained by  incising  the  unripe  capsules  of  Papaver  somniferum. 

In  medicinal  doses  it  produces  a  soothing  calm  of  body  and  mind, 
with  pleasant  fancies  and  a  disposition  to  sleep ;  the  pulse  becomes 
slower,  the  pupils  contract  slightly  and  the  skin  is  moist.  In  larger 
doses,  it  causes  redness  of  the  face,  heat  and  fullness  of  the  head 
and  marked  contraction  of  the  pupils ;  the  mind  is  excited  even  to 
delirium,  the  pulse  full  and  frequent  and  the  skin  hot  and  dry.  De- 
pression follows,  with  slow  pulse,  pale  and  damp  skin,  nausea,  torpid 
mind  and  uncertain  gait.  The  digestive  functions  are  impaired  and 
the  bowels  constipated. 

From  official  documents  it  appears  that  over  400,000  pounds  of 
opium  are  annually  imported  and  consumed  in  the  United  States ; 
300,000  are  manufactured  into  morphine,  and  it  is  estimated  that 
80  per  cent,  of  this  alkaloid  is  used  by  victims  of  the  habit.  To 
show  the  appalling  extent  of  this  evil  in  the  United  States,  it  is 
enough  to  note  that  Germany,  with  65,000,000  inhabitants,  con- 
sumes only  about  17,000  pounds  of  opium  annually. 

Morphine,  by  those  addicted  to  its  use,  is  usually  self-adminis- 
tered by  hypodermic  injections,  so  that,  in  the  habitue,  the  scars 
of  numerous  punctures  are  found  on  the  arms  and  other  parts  of 
the  body.  As  with  alcohol  and  tobacco,  the  primary  stimulation  is 
followed  by  debility  and  depression  which  nothing  but  a  fresh  re- 
sort to  the  drug  relieves ;  the  longer  it  is  used  the  larger  the  dose 
required  and  the  more  deep-rooted  the  habit.  In  spite  of  the  ter- 
rible sufferings  morphinism  entails,  including  throbbing  pains, 
spasms,  neuralgia,  insomnia,  fearful  anxiety,  hallucinations,  etc., 
such  is  its  powerful  hold  on  its  victims  that  they  are  very  seldom 
completely  cured. 

The  habitual  morphine  consumer  may  be  recognized  by  great 
emaciation,  flabby  muscles,  inability  to  execute  quick  and  complex 
movements,  pale  skin,  contracted  pupils,  general  nervousness,  tremu- 
lousness  of  the  hands,  disturbed  mentality  ranging  from  abnormal 
vivacity  and  excitement  to  sluggishness  and  torpidity.  His  moral 
sense  is  blunted  and  distorted. 


THE   TOBACCO    AND   DRUG    HABIT.  139 

Opium  smoking  is  a  vice  seldom  if  ever  indulged  in  among  sol- 
diers and  needs  no  further  mention  here. 

The  synthetic  alkaloid  heroin  (diacetyl-morphine)  is  an  allied 
narcotic,  the  addiction  to  which  is  likewise  readily  formed  and  leads 
to  the  most  deplorable  results.  It  is  taken  hypodermically  or  else 
as  a  snuff;  in  the  latter  case  the  patient  generally  suffers  from 
chronic  rhinitis.  Otherwise  the  symptoms  closely  resemble  those 
of  the  morphine  habit. 

Cocaine  is  an  alkaloid  obtained  from  the  leaves  of  Erythroxylon 
coca,  a  small  South  American  shrub. 

In  its  native  country  the  leaves  are  used  as  a  gentle  stimulant, 
diaphoretic  and  an  aid  to  digestion.  Medicinally,  cocaine  is  mostly- 
used  as  a  local  anaesthetic.  When  absorbed  in  sufficient  quantity, 
it  produces  a  pleasurable  glow  throughout  the  body,  a  general  sense 
of  cheerfulness  and  elation,  relief  from  worries  and  an  increase  of 
bodily  and  mental  vigor.  These  symptoms  are  associated  with  a 
remarkable  endurance  of  fatigue  and  insensibility  to  hunger.  After 
larger  doses,  the  pulse  is  quick,  feeble  and  thready,  the  skin  pale 
and  cold,  the  respiration  shallow,  slow  and  labored,  the  pupils  dilated 
and  insensible  and  the  vision  blurred.  Formication  has  been  noted. 
Hallucinations,  convulsions  and  even  maniac  violence  may  also 
occur. 

Most  persons  addicted  to  the  cocaine  habit  take  this  narcotic  by 
way  of  the  nostrils,  in  snuff,  and  seldom  use  the  hypodermic  syringe. 
Therefore,  in  suspected  cases,  the  membrane  over  the  cartilaginous 
septum  should  be  inspected  for  signs  of  inflammation  and  ulceration. 
The  intoxicating  effects  of  cocaine  are  described  as  being  much 
more  enticing  than  those  of  morphine  and  the  habit  has  become 
alarmingly  widespread  in  this  country.  As  in  the  case  of  morphin- 
ism, it  is  most  difficult  of  eradication. 

The  many  manifestations  of  cocainism  are  varied  and  confusing. 
At  first  are  noticed  anorexia,  dyspepsia,  constipation,  restlessness, 
insomnia,  inability  to  concentrate  the  mind.  Later,  the  body  is 
emaciated ;  the  face  pale  and  cadaveric,  with  sunken,  wandering 
eyes,  dilated  and  insensible  pupils,  twitching  muscles  and  lack  of 
co-ordination.  There  is  impairment  or  loss  of  memory  and,  at 
times,  emotional  excitement  with  voluble  talk,  hallucinations  and 
delusions  of  persecution.  Epistaxis  from  nasal  ulcerations  is  not 
rare. 


I4O  MILITARY    HYGIENE. 

Careful  experiments  have  shown  that  cocaine,  after  exhausting 
work  or  forced  marching,  will  temporarily  restore  physical  and 
mental  vigor,  and  blunt  the  sensation  of  hunger.  This,  however, 
is  at  the  expense  of  the  reserve  energy  stored  in  the  system  and 
which  must  be  made  up  by  sufficient  rest  later.  The  use  of  cocaine 
for  this  purpose  may  be  permissible  in  individual  cases,  by  persons 
of  discretion,  under  medical  supervision ;  but  for  a  body  of  men, 
there  are  no  conceivable  circumstances  which  would  make  its  use 
desirable  and  justifiable,  and  where  coffee  or  tea  would  not  be  more 
serviceable. 

In  the  Army  and  Navy,  the  attempt  to  cure  men  addicted  to  drug 
habits  is  futile  and  dangerous ;  the  only  logical  course  to  pursue 
is  to  promptly  discharge  them  from  the  service. 


CHAPTER  XIII. 
DISEASE-TRANSMITTING  ANIMALS. 

Man  is  the  chief  transmitter  of  the  diseases  from  which  he  suffers. 
With  few  exceptions,  it  is  through  his  agency,  direct  or  indirect, 
that  they  are  disseminated.  But  the  germs  of  some  of  them  are 
also  conveyed,  sometimes  exclusively  so,  from  man  to  man  by 
insects  and  vermin  with  which  man  is  more  or  less  in  contact.  A 
few  diseases  special  to  domestic  animals  may  be  likewise  directly 
transmitted  to  man ;  for  instance,  glanders  by  the  horse  and  mule, 
anthrax  by  cattle  and  sheep,  hydrophobia  by  the  dog  and  cat. 

Animal  carriers  or  transmitters  of  disease  may  be  conveniently 
classified  and  described  as  follows : 

Class  Arachnida.  Animals  with  wingless  body  consisting  of  only 
two  regions,  the  cephalo-thorax  and  abdomen,  distinctly  divided  in 
spiders  and  scorpions,  but  merged  together  in  mites  and  ticks.  Also 
distinguished  from  insects  in  having  four  pairs  of  legs. 

Order  Acarina.     Includes  Mites  and  Ticks. 

The  mites  are  mostly  very  minute  animals.  The  most  notable  is 
Sarcoptes  scabiei,  the  cause  of  true  itch  or  scabies.  The  egg-bear- 
ing female  tunnels  in  the  skin,  chiefly  between  the  fingers  and  on 
flexor  surfaces,  and  lodges  at  the  blind  end  of  the  tunnel,  along 
which  are  scattered  feces,  eggs  and  larvae.  Another  troublesome 
mite  is  the  "red  bug"  or  "harvest  mite"  (Troinbidium),  which 
attacks  both  man  and  animals  in  autumn.  Other  kinds  are  found  in 
sugar  (causing  "grocers'  itch"),  cheese,  flour  and  dry  fruits. 

Family  Ixodidae.  Ticks  Animals  with  ovate,  oval  or  rounded 
bodies  without  articulation  or  division  into  segments,  the  head, 
thorax  and  abdomen  being  merged  together  into  one  piece.  Gener- 
ally the  rostrum  (mouth  parts)  is  visible  at  the  anterior  end,  form- 
ing what  is  commonly  regarded  as  the  head,  but  in  the  suborder 
Argasince  the  rostrum  is  concealed  by  the  overlapping  cephalo-thorax 
so  that  the  animal  appears  headless. 

Recent  researches  have  shown  that  ticks  play  an  important  part 
in  the  transmission  of  disease.  They  are  widely  distributed,  and 
almost  every  mammal  is  liable  to  attacks  from  one  or  more  kinds. 

141 


142  MILITARY    HYGIENE. 

The  species  of  particular  interest  to  the  sanitarian  are  Ornitho- 
doros  moiibata,  the  transmitter  of  the  spirochete  of  African  relaps- 
ing fever ;  Argas  persicus,  the  transmitter  of  the  germ  of  the  Miana 
disease  of  Russia  and  Asia ;  Margaropus  annulatus,  which  conveys 
the  protozoon  (Babesia  bigemina)  of  Texas  fever;  and  Dermacentor 
andcrsoni  of  North  America,  the  usual  transmitter  of  the  germ  of 
the  Rocky  Mountain  spotted  fever  (see  page  84).  Doubtless  other 
species  will  be  found  capable  of  conveying  disease  to  man. 

Dermacentor  andersoni  Stiles  (D.  venustus  Banks).  Adult  male 
and  female  about  the  same  size,  namely,  4  by  2.5  mm.,  but  the 
female,  when  gorged  with  blood,  becomes  at  least  three  times  as 
large.  The  male  has  a  hard  plate  or  shield  covering  the  entire  back 
and  decorated  with  a  somewhat  complicated  pattern  of  white  and 
brown  stripes.  In  the  female  the  shield  is  much  smaller,  covering 
only  the  anterior  portion  of  the  body.  Like  other  species,  this  tick 
exists  under  four  distinct  stages,  namely,  egg,  larva,  nymph  and 
adult.  The  eggs  are  deposited  on  the  ground  in  large  masses  (sev- 
eral thousands).  The  larvae  (seed  ticks)  which  emerge  from  the 
eggs  are  minute  six-legged  animals.  After  feeding  upon  a  suitable 
host,  they  drop  to  the  ground  and  molt,  becoming  nymphs.  In  this 
stage  they  have  eight  legs,  but  no  genital  organs.  The  nymph  waits 
until  it  can  attach  itself  to  a  host,  engorges  blood,  drops,  molts  its 
skin  and  becomes  adult.  Although  a  few  of  the  individual  ticks 
may  complete  their  life  cycle  during  one  season,  the  majority 
require  two  years. 

A  very  important  peculiarity  of  this  tick  is  that  when  the  adult 
becomes  infected  with  spotted  fever,  the  germs  of  the  disease  pass 
through  the  eggs  to  the  young  of  the  next  generation,  which,  even 
as  larvae  and  nymphse,  may  thus  transmit  the  infection.  This  power 
of  transmission  has  also  been  'observed  in  the  tick  of  the  African 
relapsing  fever,  as  well  as  in  that  of  the  Texas  cattle  fever,  so  that 
it  presumably  exists  in  most  species. 

The  area  infested  by  this  tick  includes  the  northern  Rocky  Moun- 
tain region  in  the  United  States,  and  the  valleys  and  plains  to  the 
east  and  west  of  it,  from  Montana,  Wyoming,  Colorado  and  New 
Mexico  through  Idaho  and  Utah  to  Washington,  Oregon  and 
Nevada.  It  also  occurs  in  southern  British  Columbia  and  in  the 
Rocky  Mountains  of  Canada. 

The  animals  which  act  as  hosts  are  many,  including  cattle  and 


DISEASES  —  TRANSMITTING    ANIMALS.  143 

other  domestic  animals,  and  most  of  the  wild  animals  of  the  region. 
The  adult  tick  is  found  mostly  on  cattle  and  horses,  while,  in  the 
immature  stages,  it  is  found  only  on  small  wild  animals. 

Five  other  species  of  ticks  have  been  observed  in  the  Bitter  Root 
Valley  of  Montana,  but  their  host  relations  are  such  as  to  render 
them  comparatively  harmless. 

According  to  the  experiments  of  Maver,  spotted  fever  may  be 
transmitted  by  various  species  of  ticks,  so  that  it  is  very  important 
to  prevent  the  spread  of  the  infection  to  new  territory  where  are 
found  ticks  more  or  less  related  to  Dermacentor  andersoni  and,  like 
it,  known  to  attack  man.  These  dangerous  species  are  D.  occiden- 
talis  of  California  and  Oregon,  Amblyomma  americanum  (lone-star 
tick)  and  D.  variabilis  (American  dog-tick)  of  the  Southern  and 
Eastern  States,  Amblyomma  maculatum  of  the  Gulf  Coast  and  A. 
cajcnnense  of  Texas  and  New  Mexico. 

Inasmuch  as  those  ticks  which  are  dangerous  to  man  also  feed  on 
cattle,  horses,  sheep  and  other  domestic  animals,  the  most  practical 
and  effective  way  to  destroy  them  is  to  dip  these  animals  as  often 
as  may  be  necessary,  during  the  proper  season,  in  an  insecticide  bath, 
such  as  an  arsenical  solution  or  crude  oil.  Where  dipping  is  not 
practicable,  hand  treatment  of  these  animals  should  be  resorted  to. 
The  killing  of  the  small  wild  animals  which  serve  as  hosts  to  the 
ticks  in  their  immature  stages  is  also  useful,  as  well  as  the  clearing 
and  burning  of  the  brush  in  the  shelter  of  which  the  eggs  hatch  and 
the  larvae  and  nymphoe  wait  for  their  prey. 

Class  Hexapoda.  Insects  proper.  Body  with  three  distinct 
regions,  head,  thorax  and  abdomen ;  the  thorax  consisting  of  three 
segments,  the  prothorax  in  front  (sometimes  hardly  distinguishable), 
the  mesothorax  or  main  segment,  and  the  metathorax  or  rear  seg- 
ment, each  bearing  a  pair  of  legs.  Generally  the  mesothorax  and 
sometimes  the  metathorax  bear  a  pair  of  wings.  Eyes  both  com- 
pound and  simple. 

Order  Hemiptera.  Mouth-parts  consisting  of  a  horny  sheath  in- 
closing three  sharp  bristle-like  organs,  the  whole  forming  a  sucking 
proboscis. 

Family  Cimicidae.  Genus  Cimex.  Bedbug.  Wingless  insects 
with  brownish-red,  flattened  body  and  penetrating  odor.  The  eggs 
are  deposited  in  cracks,  and  in  10  days  hatch  out  into  larvae  which 
develop  into  adults  by  a  series  of  meltings. 


144  MILITARY    HYGIENE. 

Two  species  are  of  interest  as  disease  bearers :  C.  lectularius,  the 
common  cosmopolitan  species,  and  C.  rotundatus,  of  tropical  and 
semi-tropical  regions,  with  shorter,  rounded  abdomen. 

A  striking  peculiarity  of  the  common  species  is  its  ability  to  sur- 
vive for  long  periods  without  food,  specimens  having  remained  alive 
for  a  year  in  a  sealed  vial  with  absolutely  no  means  of  sustenance 
(Marlatt}.  It  is  the  carrier  of  European  relapsing  fever.  Dutton 
by  experiments,  and  Riggs,  U.  S.  Navy,  by  observations,  have 
shown  that  it  transmits  typhoid  fever,  the  virulency  of  the  typhoid 
bacillus  remaining  undiminished  in  its  body  for  several  weeks.  Ac- 
cording to  Howard  and  Clark,  it  can  absorb  the  virus  from  the 
blood  of  a  poliomyelitis  patient  and  maintain  it  active  within  its 
body  for  at  least  seven  days.  Also  probably  capable  of  transmitting 
plague.  The  rotundatus  is  believed  to  be  connected  with  the  trans- 
mission of  kala-azar  and  probably  leprosy.  Kerr.  U.  S.  Navy, 
found  large  numbers  of  acid-fast  bacilli  in  bedbugs  fed  on  the 
infected  areas  of  leprosy  patients. 

According  to  Ricker,  this  animal  conveys  pathogenic  germs  with 
its  saliva  into  the  wound,  like  the  mosquito. 

For  destruction  of  bedbugs,  see  page  495. 

To  an  allied  family  of  the  same  order  belongs  the  Texas  or  Mexi- 
can bedbug  (Conorhinus),  a  winged  insect  with  dark-brown  body 
nearly  an  inch  long,  and  a  projecting,  narrow  head.  Its  bite  is  much 
more  severe  than  that  of  the  common  bedbug. 

Family  Pediculidae.  Genus  Pediculus.  Louse.  Wingless  in- 
sects hatched  from  acorn-shaped  eggs  or  nits,  and  without  metamor- 
phosis. Three  species  are  parasitic  on  man: 

P.  capitis.  Head-louse.  Thorax  as  broad  as  the  abdomen.  Eggs 
deposited  on  the  hairs  of  the  head. 

P.  vestimenti.  Body  or  Clothes-louse.  Larger  than  the  preced- 
ing the  abdomen  broader  than  the  thorax.  Eggs  deposited  in  the 
clothing. 

P.  pubis.  Crab-louse.  With  almost  square  body,  and  large  claws. 
Preferably  inhabiting  the  pubic  region,  but  may  also  be  found  in 
other  hairy  parts  of  the  body. 

The  body-louse  and  head-louse  have  been  proved  to  be  the  ordi- 
nary carriers  and  agents  of  trasnmission  of  typhus  fever  and  recur- 
rent fever  (which  see).  They  are  also  suspected  of  transmitting 
relapsing  fever  and  possibly  leprosy.  Lice  feeding  on  typhoid-fever 
patients  have  been  found  to  contain  the  bacillus  of  this  infection. 


DISEASES TRANSMITTING    ANIMALS.  145 

Of  insect  parasites,  lice  are  the  most  loathsome,  but  also  the  most 
easily  gotten  rid  of.  Any  soldier  infested  with  either  kind  should 
be  promptly  isolated  and  subjected  to  vigorous  treatment  so  as  to  de- 
stroy both  insect  and  egg.  In  case  of  head  infection,  or  of  other  hairy 
parts  of  the  body,  the  hair  is  cut  very  short,  shampooed  and  washed 
with  kerosene  oil  or  a  solution  of  formalin  (4/100).  Kerosene  is 
a  powerful  destroyer  of  lice  and  eggs ;  it  can  be  used  by  spray  or 
directly  with  a  cloth.  The  body-louse  is  destroyed  by  disinfecting 
the  clothing  in  steam,  boiling  it  in  water  or  immersing  it  for  at 
least  one  minute  in  gasoline.  Dry  heat  is  also  very  effective.  For 
blankets  and  woolen  clothing  there  is  nothing  better  than  a  hot  flat- 
iron  well  pressed  down.  Insect  powder  may  be  used  on  outside 
garments.  Great  attention  must  be  given  to  the  eggs  or  nits  found 
attached  to  the  hairs  and  the  fibres  of  the  clothing,  especially  along 
the  seams. 

Order  Siphonaptera.  Family  Pulicidae.  Subfamily  Pulicinae. 
Fleas.  Wingless  insects,  with  two  simple  eyes  and  no  compound 
eyes.  Antennae  inconspicuous.  Edges  of  head  and  prothorax 
armed  with  stout  spines  directed  backward.  Puncturing  apparatus 
consisting  of  long,  serrate  mandibles  and  epipharynx,  together  form- 
ing a  tube  through  which  the  blood  is  sucked  up.  Body  compressed 
laterally  and  hind  legs  specially  adapted  for  leaping.  The  eggs  of 
fleas  are  laid  in  the  dust  of  crevices  and  hatch  in  about  a  week. 
The  larva  forms  a  cocoon,  molts  into  a  nymph  and  emerges  as  adult 
about  three  weeks  later. 

Fleas  are  the  transmitters  of  bubonic  plague  from  infected  rats 
to  man  (see  page  86). 

The  most  important  species  in  this  connection  are  Xenopsylla 
cheopsis,  Ceratophyllns  fasciatus,  C.  anisns,  Ctenopsylla  mitscnli, 
Cteriophthalmus  agyrtes.  X.  cheopsis  is  the  most  prevalent  in  the 
tropics  and  subtropical  regions ;  it  is  also  common  during  summer 
and  autumn  in  port  towns  of  temperate  zones  having  maritime  inter- 
course with  the  tropics  (Marseilles,  London,  San  Francisco,  etc.). 
In  cooler  regions,  C.  fasciatus  is  the  most  universally  distributed, 
being  associated  more  or  less  with  Ct.  musculi  and  Ct.  agyrtes.  The 
latter  species  seems  to  be  the  most  common  rat  flea  in  England,  but 
very  seldom  bites  man.  In  Japan,  C.  fasciatus  is  replaced  by  C. 
anisus,  a  closely  allied  species.  X.  cheopsis  and  C.  fasciatus  are  the 


146  MILITARY    HYGIENE. 

species,  which,  when  hungry,  readily  bite  man,  and  therefore  the 
most  dangerous.* 

The  dog  and  cat  flea  (Ct.  canis)  and  the  human  flea  (Pulex  irri- 
tans)  may  also  be  found  accidentally  on  rats,  but  too  rarely  to  play 
any  part  in  plague  transmission.  In  this  country,  the  dog  and  cat 
flea  is  much  more  likely  to  become  a  nuisance  in  houses  than  the 
human  flea  which  seldom  occurs  in  great  numbers.  According  to 
the  experiments  of  W.  F.  Dutoon,  it  is  capable  of  inoculating  the 
germs  of  typhoid  fever. 

To  get  rid  of  fleas  all  rugs  and,  if  necessary,  mattings  and  carpets 
must  be  removed,  beaten  and  then  dusted  with  pyrethrum  powder 
or  sprinkled  with  benzine  or  gasoline.  The  floor  is  then  scrubbed, 
especially  the  cracks  and  crevices,  with  hot  soapsuds  or  a  kerosene 
emulsion,  or  (which  is  much  more  effective)  a  5  per  cent,  emulsion 
of  creolin.  The  house  dogs  and  cats  must  be  washed  with  soapsuds 
and  then  freely  dusted  with  pyrethrum  or  sprayed  with  benzine; 
but  still  more  effective  is  a  good  washing  with  a  3  per  cent,  solution 
of  creolin.  Another  plan  to  rid  a  room  of  fleas  is  to  turn  guinea 
pigs  loose  into  it ;  after  the  fleas  have  collected  on  these  animals 
they  are  stupefied  with  chloroform  spray,  combed  out  and  burned. 
The  most  reliable  method  is  doubtless  sulphur  fumigation  wherever 
its  destructive  action  upon  fabrics  and  metals  is  not  to  be  feared. 

To  the  subfamily  Sarcopsyllince  belongs  Sarcopsylla  penetrans,  the 
chigo,  jigger  or  sand  flea  of  warm  countries,  not  unlike  a  reddish 
flea  in  size  and  appearance,  but  distinguished  by  the  larger  head, 
which  is  distinctly  pointed,  somewhat  like  that  of  a  fish.  The 
female,  when  impregnated,  bores  its  way  into  the  skin  of  man, 
especially  the  soles  of  the  feet  and  about  the  toes,  and  then  distends 
enormously,  even  to  the  size  of  a  small  pea.  The  treatment  consists 
in  the  enucleation  of  the  entire  insect  with  a  sharp  needle. 

Order  Orthoptera.  Mostly  winged  insects,  with  wings  lying 
straight  along  the  back,  the  under  ones  larger  and  thinner  and  folded 
in  plaits. 

Family  Blattidae.     Cockroaches.     Four  species  are  described  by 

*  In  an  investigation  of  the  rats  of  Providence,  R.  I.,  and  their  parasites, 
in  1912,  Geo.  H.  Robinson  found  that,  of  341  rats  captured,  333  were  the 
brown  or  Norway  rat:  that  195  were  infested  with  fleas,  and  that,  of  these 
fleas  (as  determined  by  Nathan  Banks),  75  per  cent,  were  Xenopsylla  cheop- 
sis  and  22  per  cent.  Ceratophyllus  fasciatus.  These  surprising  results  show 
the  necessity  of  further  investigations  to  ascertain  the  climatic  distribution 
of  fleas. 


DISEASES  —  TRANSMITTING   ANIMALS. 


147 


Marlatt  as  the  most  common  in  this  country :  the  American  roach 
(Periplaneta  americana')  (Fig.  13),  Australian  roach  (P.  aiistra- 
l&sia},  Oriental  roach  or  black-beetle  of  Europe  (Blatta  orientalis} , 
and  German  roach  (Blatella  germanica).  In  the  Oriental  roach  the 


FIG.  13. —  The  American  roach  (Periplaneta  americana)  :  a,  View  from  above; 
b,  from  beneath.     (From  C.  L.  Marlatt.) 

wings  are  only  rudimentary  in  the  female,  and  rather  short  in  the 
male.  In  the  other  three  species  the  wings  are  well  developed  in 
both  sexes.  The  German  roach  or  "  Croton  bug,"  the  smallest  of 
our  domestic  species,  and  easily  recognized  by  the  two  converging 
dark  stripes  on  the  thorax,  has  become  the  commonest  in  the  eastern 
United  States.  (Fig.  14.) 


FIG.  14. —  The  German  roach  (Blattella  germanica}  :  a,  First  stage;  b,  sec- 
ond stage ;  c,  third  stage ;  d,  fourth  stage ;  e,  adult ;  /,  adult  female  with  egg- 
case;  g.  egg-case,  enlarged;  h,  adult  with  "wings  spread.  All  natural  size 
except  g.  (From  Riley.) 


148  MILITARY    HYGIENE. 

Nocturnal  animals,  omnivorous  and  destructive,  infesting  kitchens, 
pantries  and  storerooms;  also  objectionable  from  the  nauseous  and 
persistent  odor  of  their  secretions.  They  are  accused  of  infecting 
food  and  milk  with  intestinal  bacilli,  and  of  distributing  destructive 
molds  and  pyogenic  organisms.  Also  suspected  of  disseminating 
the  germs  of  tuberculosis  and  typhoid  fever.  Gales,  from  long 
experience  with  epidemics  in  the  U.  S.  Navy,  believes  that  roaches 
are  often  responsible  for  the  spread  and  continuance  of  typhoid 
fever,  diphtheria,  tonsillitis  and  tuberculosis.  Riggs,  U.  S.  Navy, 
traced  an  epidemic  of  paratyphoid  fever  on  board  ship  to  these 
animals.  Longfellow  (Toledo  Clinical  Laboratories}  claims  to  have 
proven  that  roaches  can  and  do  carry,  on  their  feet  and  in  their 
viscera,  all  of  the  common  bacteria  of  the  acute  infectious  diseases, 
as  well  as  any  others  met  in  their  travels. 

The  most  effective  means  for  their  destruction  is  fumigation  with 
hydrocyanic  acid  or  sulphurous  acid.  A  phosphorous  paste  made 
of  sweetened  flour  paste  containing  i  or  2  per  cent,  of  phosphorus, 
is  effective.  Pulverized  sodium  fluoride  used  as  an  insect  powder 
is  highly  spoken  of  in  the  Navy.  Suitable  traps  are  also  very  useful. 

Order  Diptera.  Insects  with  only  two  wings,  borne  on  the  meso- 
thorax,  and  a  pair  of  knobbed  threads  (the  halteres  or  balancers) 
borne  on  the  metathorax.  Mouth  formed  for  sucking  or  lapping. 
Includes  the  insects  most  concerned  in  the  transmission  of  disease. 
The  principal  families  are  readily  distinguished  by  the  wing 
venation.* 

Family  Muscidae.     True  Flies. 

Musca  domcstica.  Common,  Domestic  or  House-fly.  (Fig.  15.) 
By  far  the  most  abundant  of  flies,  forming,  according  to  Howard, 
nearly  99  per  cent,  of  all  flies  caught  in  houses. f  Following  man 
into  all  but  the  coldest  climates,  it  is  found  in  practically  all  parts  of 
the  world  as  a  household  insect.  Wherever  troops  form  camp  in 
this  country,  or  any  of  our  colonies,  however  desert  and  sterile  the 
place,  flies  will  be  present.  It  is  true  that  in  many  situations  the 
domestic  fly  is  associated  with  or  entirely  replaced  by  other  species 
undistinguishable  from  it  to  the  average  observer. 

It  is  differentiated  from  similar  species  by  the  following  char- 

*  Simple  methods  of  differentiating  disease-bearing  insects.     C  S.  Ludlow. 
The  Military  Surgeon,  July,   1912. 
t  The  House  Fly.     Disease  carrier.    L.  O.  Howard. 


DISEASES  — TRANSMITTING   ANIMALS. 


149 


acteristics :  Four  black  lines  on  the  back  of  the  thorax ;  vein  ending 
near  the  tip  of  the  wing  distinctly  elbowed  a  short  distance  from  the 
tip;  absence  of  bristles  on  the  abdomen  except  at  the  end.  The 
head  consists  chiefly  of  the  large  compound  eyes,  made  up  of  thou- 
sands of  facets ;  between  them,  above,  are  three  simple  eyes ;  thus 


FIG.  15. —  The  common  house-fly  (Musca  domestica)  :  Puparium  at  left; 
adult  next,  then  antenna  (with  feathery  bristle)  and  larva.  All  enlarged. 
(From  L.  O.  Howard.) 

can  a  fly  see  in  all  directions.  Below,  in  front,  are  two  large  pendant 
organs,  the  antenrue  or  feelers,  each  with  a  large  feathery  bristle. 
Still  further  down  are  the  mouth  parts  or  proboscis,  a  curious  jointed 
appendage  with  another  pair  of  feelers  (maxillary  palpi)  at  the 
base ;  at  the  tip  it  expands  into  two  lobes  covered  with  transverse 
hard  ridges ;  between  the  lobes  is  the  oral  orifice.  Fluid  substances 
are  readily  sucked  up.  With  soluble  solids  the  process  is  more 
complex ;  the  oral  lobes,  widely  opened,  are  closely  applied  to  the 
solid  surface ;  saliva  (or  fluid  from  the  crop)  is  freely  ejected  upon 
it  and  strong  sucking  movements  made,  with  rasping  frictions  of  the 
hard  ridges  of  the  lobes,  until  some  of  the  substance  is  sufficiently 
dissolved  to  be  absorbed. 

Each  of  the  six  feet  consists  chiefly  of  two  sticky  pads  and  two 
claws.  (Fig.  1 6.)  The  pads  are  covered  with  numerous  minute 
hairs,  viscous  at  the  end,  making  them  stick  to  everything  they 
touch.  On  smooth  surfaces  the  fly  adheres  by  the  combined  action 
of  pads  and  claws,  while  on  rough  surfaces  it  clings  mostly  by  its 
claws.  This  stickiness  of  the  feet  is  one  of  the  reasons  which 
render  the  house-fly  dangerous ;  they  constantly  become  clogged 
with  adhering  substances,  mostly  microscopic  particles,  which  are 
thus  carried  from  one  place  to  another.  Considering  the  wonderful 


I5O  MILITARY    HYGIENE. 

activity  and  strength  of  the  house-fly,  much  surpassing  those  of  any 
bird  in  comparison  to  size,  we  can  readily  realize  the  amount  of 
matter  thus  carried  about.  As  this  clogging  interferes  with  the  free 
action  of  its  feet,  the  fly  is  frequently  seen  preening  itself  and  lap- 
ping off  the  collected  dirt  which  thus  enters  the  stomach  and  passes 
out  with  the  excreta. 


FIG.  16. —  Foot  of  the  house-fly.  (From  Elements  of  Zoology  by  Sanborn 
Tenney.  Copyright,  1875  and  1903.  Reproduced  by  permission  of  the  Ameri- 
can Book  Company.) 

The  house-fly  lays  its  eggs  preferably  upon  horse  manure,  which 
seems  to  be  the  favorite  food  of  its  larvae ;  but  it  also  oviposits  on 
human  excrement  and  all  kinds  of  manure ;  in  the  absence  of  better 
material  it  will  breed  in  decaying  vegetable  and  animal  substances, 
as  well  as  in  fermenting  garbage  and  rubbish. 

The  female  lays  about  120  eggs,  in  small  irregular  clusters.  They 
are  glistening  white  in  color,  cylindrical-ovoid  in  shape,  one-twen- 
tieth of  an  inch,  or  little  more,  in  length.  (Fig.  15.  )  They  hatch 
in  about  8  hours.  The  white,  conical  larva  undergoes  several  melt- 
ings, often  turning  yellowish,  and  reaches  the  pupal  stage  in  about 
five  days,  being  then  about  6  mm.  long.  From  the  moment  of 
hatching  it  is  very  active,  burrowing  into  the  substance  upon  which 
the  egg  was  laid  and  rapidly  disappearing  from  sight.  The  pupa  is 
nearly  cylindrical,  with  both  ends  evenly  rounded,  and  rapidly 
changes  in  color  from  yellowish  to  red  and  finally  to  a  dark  chest- 
nut. Its  duration  is  also  five  days,  making  an  average  period  of  ten 
days  from  the  time  of  oviposition  to  the  emergence  of  the  adult  fly. 

The  great  majority  of  flies  oviposit  only  once  or  twice,  but,  excep- 


DISEASES TRANSMITTING   ANIMALS.  151 

tionally,  females  have  been  observed  to  lay  three  or  four  times.  As 
it  requires  10  days  for  the  evolution  of  the  full-fledged  insect  and 
about  10  days  more  for  the  young  fly  to  attain  sexual  maturity,  a 
new  generation  may  therefore  be  expected  every  20  days,  that  is  to 
say,  six  or  seven  generations  during  the  summer  from  any  one 
female  which,  after  hibernating,  begins  to  lay  about  April  15.  A 
simple  calculation  will  show  that,  from  this  female  ancestor,  numer- 
•ous  billions  of  flies  may  be  bred  before  autumn.  It  is  not  unusual  to 
find  1,000  maggots  to  the  pound  of  manure ;  as  many  as  200  have 
been  counted  in  less  than  one  cubic  inch  of  it. 

The  eggs,  larvae,  most  of  the  pupae,  as  well  as  all  unprotected  flies, 
are  killed  when  the  frosts  come,  the  species  being  perpetuated  by 
the  impregnated  females  that  find  suitable  shelters  in  which  to 
hibernate,  and  the  comparatively  few  pupae  sufficiently  protected 
under  manure  heaps. 

Levy  and  Tuck  record  the  very  important  observation*  that  the 
larvae  of  the  house-fly  remain  in  the  manure  heap  only  until  they 
have  attained  their  full  growth,  and  that  they  then  leave  it  and  enter 
the  earth  wherever  it  is  possible  for  them  to  do  so,  the  full-grown 
maggots  being  mostly  found  on  the  outer  edges  of  the  heap,  whence 
they  rapidly  burrow  into  the  ground.  We  may  therefore  accept  the 
fact  that  the  house-fly  does  not  pupate  in  manure  if  the  full-grown 
maggots  can  find  any  means  of  reaching  and  entering  the  earth;  in 
other  words,  that  the  soil  is  the  normal  place  for  its  final  transfor- 
mations. Of  course,  when  the  manure  is  placed  in  closed  containers, 
the  larvae,  unable  to  escape,  will  enter  the  pupal  stage  within  it. 
In  due  time,  if  left  undisturbed,  the  adult  fly  finds  its  way  to  the 
surface,  generally  through  the  hole  made  by  its  larva.  Stiles  has 
shown  that  a  certain  proportion  of  flies,  hatched  from  eggs  buried 
under  four  feet  of  sand,  will  find  their  way  out.  Doubtless  the 
larvae  had  crawled  up  as  high  as  possible  before  pupating.  The 
maggots  scattered  with  the  manure  upon  the  surface  of  the  ground 
are  much  more  likely  to  be  destroyed  by  dryness  than  by  any  thick- 
ness of  earth  ploughed  upon  them.  It  is  likewise  probable  that  most 
of  the  flies  bred  in  the  contents  of  earth-closets  or  open  privies  will, 
in  the  absence  of  special  preventive  measures,  find  their  way  out  of 
them. 

*  Am.  J.  of  Public  Health.    July.  1913. 


152  MILITARY    HYGIENE. 

The  transmission  of  disease  by  flies  is  effected  in  three  ways: 
i,  by  direct  conveyance  of  the  germs  on  various  parts  of  their 
bodies ;  2,  through  the  liquid  vomited  from  the  crop ;  3,  through  the 
intestinal  discharges  or  fly-specks. 

It  has  already  been  seen  that  the  feet  are  well  adapted  to  collect 
and  transport  microorganisms,  but  other  parts  of  the  body  can  also 
act  as  carriers,  especially  the  large  proboscis  and  the  hairy  legs. 
Knowing  the  predilection  of  the  fly  for  filth,  including  human  excre- 
ment, and  the  ceaseless  activity  which  leads  it  from  latrines,  manure 
piles  and  dumps  to  kitchens  and  mess-rooms,  we  realize  how  per- 
nicious it  may  be.  The  investigations  of  Esten  and  Mason,  who 
studied  the  bacterial  population  of  several  hundred  flies,  show  that 
the  average  for  each  was  over  a  million  organisms.  One  fly  falling 
into  a  pan  of  milk  may  therefore  be  responsible  for  the  millions  of 
bacteria  to  the  c.  c.  found  in  it  a  few  hours  later.  Fortunately,  the 
experiments  of  Graham- Smith  have  proved  that  the  pathogenic  bac- 
teria collected  on  the  proboscis,  legs  and  wings  do  not  usually  sur- 
vive more  than  a  few  hours.  Much  more  dangerous  are  those 
which  come  from  within  the  body. 

In  the  alimentary  canal  of  the  house-fly  is  found  a  diverticulum 
or  crop  which  is  a  temporary  storehouse  for  food ;  here  the  food 
remains  practically  unchanged.  The  contents  of  the  crop  are  drawn 
into  the  stomach,  or  they  may  be  regurgitated  through  the  proboscis, 
as  in  feeding  on  solid  food.  According  to  Graham-Smith,  it  is  these 
regurgitated  drops  which  make  the  larger  stains  upon  a  window 
covered  with  fly-specks.  Pathogenic  bacteria  frequently  survive 
several  days  within  the  crop,  and  still  longer  in  the  intestine,  but 
there  is  no  evidence  that  they  multiply  in  either  of  these  situations. 
The  digestive  fluids  appear  to  have  but  little  effect  upon  the  organ- 
isms contained  in  the  food,  and  most  of  these  can  be  recovered  in 
the  excreta. 

J.  C.  Torrey  has  investigated  the  numbers  and  types  of  bacteria 
carried  by  city  flies  (/.  Inf.  Dis.,  March,  X,  No.  2).  Fecal  bacteria 
of  the  colon-type  were  first  found  abundantly  in  the  early  part  of 
July.  The  bacteria  in  the  intestine  were  8.6  times  as  numerous  as 
those  on  the  surface;  the  colon-group  bacteria  constituted  37.5  per 
cent,  of  the  total  within  the  intestine,  and  only  13.1  per  cent,  of  those 
on  the  surface.  Of  the  streptococci  cultures  none  were  of  the 


DISEASES TRANSMITTING    ANIMALS.  153 

pyogenes  type.  Several  cultures  of  B.  paratyphosus,  type  A,  were 
obtained. 

Some  English  experiments  seem  to  indicate  that  flies  which,  as 
larvae,  fed  on  infected  fecal  matter,  will  continue  to  carry  typhoid 
germs  in  their  intestine  for  a  number  of  days  although  having  in- 
gested none  since  their  emergence  from  the  pupal  state. 

The  house-fly  is  an  enormous  feeder,  swallowing  in  the  course  of 
a  day,  under  favorable  conditions,  nearly  its  own  weight  of  food. 
While  feeding  upon  the  discharges  of  typhoid,  cholera,  dysenteric 
or  diarrheal  patients,  it  swallows  millions  of  pathogenic  bacteria. 
When  well  fed  it  defecates  every  few  minutes  during  the  day.  As  a 
natural  consequence  the  number  of  fly-specks,  wherever  flies  are  at 
all  numerous,  is  often  amazing ;  a  proportion  of  1 ,000  per  square 
foot  on  window  panes  is  not  uncommon,  and  on  neutral-tinted  sur- 
faces, less  often  cleaned,  the  proportion  may  easily  rise  to  millions 
(N.  A.  Cobb).  It  thus  clearly  appears  that  the  chief  danger  from 
the  house-fly  is  through  the  contamination  of  foodstuffs  by  fly- 
specks. 

It  must  be  considered,  next  to  the  mosquito,  the  most  dangerous 
of  insects.  It  is  a  common  disseminator  of  typhoid  fever,  and,  on 
that  account,  often  called  typhoid  fly.  It  is  also  known  to  transmit 
cholera,  dysentery,  infantile  diarrhea  and  tuberculosis.  Howard 
and  Clark  found  that  it  can  carry  the  virus  of  poliomyelitis  in  an 
active  state  for  several  days.  There  is  likewise  strong  circumstan- 
tial evidence  that  it  conveys  the  germs  of  plague,  smallpox,  leprosy, 
anthrax,  yaws,  trachoma,  ophthalmia,  erysipelas,  tropical  sore,  and 
the  eggs  of  parasitic  worms.. 

Yet,  in  spite  of  the  above  formidable  list  of  infectious  diseases, 
one  should  guard  against  being  led  to  exaggerate  the  pernicious 
activities  of  the  house-fly,  bad  as  they  may  be.  Most  of  the  experi- 
ments which  have  proved  its  guilt  were  made  under  the  favorable 
conditions  of  the  laboratory  and  with  pure  pathogenic  cultures.  It 
is  certain  that  such  conditions  seldom  prevail  in  nature,  and  that 
diseases  from  infected  flies  are  not  as  common  and  widespread  as 
one  might  believe  from  the  foregoing  statements.  Thus  Graham- 
Smith,  a  judicious  and  careful  investigator,  is  of  opinion  that  our 
knowledge  of  the  subject  does  not  afford  conclusive  evidence  that 
naturally  infected  flies  "  are  a  frequent  source  of  disease  in  man  by 
infecting  food  materials."  Other  trustworthy  authorities,  however, 


154  MILITARY    HYGIENE. 

«. 

consider  such  estimate  too  conservative  and  liable  to  encourage  dan- 
gerous neglect.  There  is  no  doubt  that  under  such  conditions  as 
often  prevail  in  military  camps,  on  many  a  country  farm  and  wher- 
ever the  primitive  open  privy  is  used,  the  house-fly  is  a  really 
dangerous  agent  in  the  transmission  of  infections. 

Prevention  and  Destruction  of  House-flies. —  Bearing  in  mind 
the  comparatively  few  flies  which  survive  the  winter,  it  is  evident 
that  the  campaign  should  begin  by  the  destruction  of  these  hibernat- 
ing females  wherever  found  in  basements,  barns,  stables  and  other 
sheltered  places.  Hibernating  mosquitoes  should  be  destroyed  at 
the  same  time.  Thus  will  the  problem  be  wonderfully  simplified, 
since  each  female  killed  then  represents  millions  of  offspring  which 
would  be  bred  during  the  summer. 

Since  flies  breed  in  excrement,  manure,  garbage  and  filth,  all  such 
material  should  be  frequently  removed  from  the  vicinity  of  houses, 
and,  until  so  removed,  carefully  screened.  Garbage  cans  must  be 
kept  covered  with  a  well-fitting  lid.  Wherever  domestic  animals  are 
kept,  there  should  be  in  connection  therewith  a  bin,  closet  or  pit 
for  the  reception  of  manure,  properly  screened  against  flies.  The 
insecticides  so  far  found  of  most  practical  value  for  the  destruction 
of  fly  maggots  in  stables  are  borax  and  hellebore.*  Borax  finely 
powdered  is  used  in  the  proportion  of  0.62  to  i  pound  per  8  bushels 
(10  cubic  feet)  of  manure,  applied  particularly  around  the  outer 
edges  of  the  pile  with  a  fine  sieve,  and  followed  by  a  sprinkling  of 
2  or  3  gallons  of  water.  If  used  carelessly  in  large  quantity,  borax 
is  liable  to  injure  vegetation,  and  for  this  reason,  hellebore,  which 
is  harmless  in  any  proportion,  should  be  preferred  when  treating 
manure  on  a  large  scale.  It  is  used  at  the  rate  of  one-half  pound 
of  the  powdered  root  to  10  gallons  of  water,  for  8  bushels  of  manure. 
Since  the  average  time  elapsing  between  the  laying  of  eggs  and  the 
escape  of  the  larvae  into  the  ground  is  three  or  four  days,  it  is 
advisable  to  have  manure  accumulations  removed  at  least  twice  a 
week.  Daily  removal  and  spreading  out  in  a  thin  layer  is  better; 
thus  spread  and  broken  up,  it  dries  quickly  and  ceases  to  be  attrac- 
tive to  flies. 

The  observations  of  Levy  and  Tuck,  above  referred  to,  have  sug- 
gested an  effective  means  of  fighting  the  fly.  If  the  manure  is  placed 

*  Bull.  No.  245,  U.  S.  Depart,  of  Agriculture. 


DISEASES — TRANSMITTING   ANIMALS.  155 

in  a  barrel  or  other  container,  in  the  bottom  of  which  several  large 
holes  have  been  bored,  and  said  container  is  set  in  a  large  tub,  from 
the  bottom  of  which  it  is  elevated  by  several  'bricks,  it  will  be  found 
that  all  the  maggots  escape  from  the  container  and  drop  into  the  tub 
in  their  efforts  to  reach  the  ground.  Surer  results  are  secured  by 
replacing  the  bottom  of  the  container  with  a  piece  of  stout  ware 
gauze  of  about  a  quarter-inch  mesh.  The  tub  should  contain  a  few 
inches  of  water  to  drown  the  maggots. 

The  preference  shown  by  flies  for  horse  droppings  seems  to  be  due 
to  the  film  of  mucous  covering  them ;  if  they  are  broken  up  and 
scattered  as  soon  as  possible  they  quickly  dry  and  do  not  become  a 
nuisance.  In  camps,  manure  not  needed  for  fertilizing  purposes  is 
best  disposed  of  by  burning.  The  sprinkling  of  kerosene  on  pol- 
luted soil  will  keep  flies  away.  The  attraction  of  dirt  for  flies  is  a 
strong  argument  for  the  strict  policing  of  camp  grounds,  especially 
in  the  vicinity  of  kitchens,  mess-tents  and  lavatories.  Latrines  re- 
quire great  care  in  this  connection,  as  described  under  the  proper 
heading. 

Under  ordinary  conditions  the  house-fly  does  not  travel  far  from 
its  breeding  place,  seldom  more  than  500  yards,  which  simplifies 
measures  of  control. 

The  exclusion  of  flies  from  houses  presents  no  serious  difficulties. 
If  the  careful  screening  of  doors  and  windows  will  not  accomplish 
it,  we  must,  besides,  have  recourse  to  fumigation  (see  Insecticides), 
fly  papers  and  traps ;  of  the  latter,  those  devised  by  Prof.  Hodge, 
of  Clark  University,  are  particularly  efficient.  Formalin  is  also  very 
useful  in  solution  of  one  part  to  seven  parts  of  milk  or  sweetened 
water,  placed  in  shallow  vessels. 

Of  the  natural  enemies  of  flies  the  most  common  and  effective  is 
a  parasitic  fungus,  Empusa  muscce,  which  carries  off  great  numbers 
of  them  in  the  early  autumn.  It  has  also  been  found  that  ants  often 
feed  voraciously  upon  the  eggs  and  larvae  of  flies  in  manure,  although 
they  cannot  always  be  relied  upon  for  the  purpose.  P.  L.  Jones, 
U.  S.  Army,  attributes  the  comparative  scarcity  of  flies  in  the 
Philippine  Islands  to  the  prevalence  of  ants,  and  advises  to  favor 
the  multiplication  of  these  predatory  little  insects  wherever  flies 
breed  abundantly. 

Other  common  flies  of  this  family,  likewise  liable  to  communicate 
disease,  are: 


156 


MILITARY    HYGIENE. 


Muscina  stabulans.  Large  House-fly.  Often  mistaken  for  the 
domestic  fly,  but  somewhat  larger  and  lacking  the  lines  on  the 
thorax  and  the  elbowed  vein  near  the  apex  of  the  wing.  Its 'larva 
feeds  upon  rotten  vegetables  and  human  excreta,  as  well  as  dung, 
and  there  is  no  reason  to  consider  it  a  special  inmate  of  stables,  as 
the  name  would  indicate. 

Stomoxys  calcitrans.  Biting  Stable-fly.  (Fig.  17.)  Recognized 
by  its  beak  or  proboscis  formed  for  blood  sucking.  Farm  yards  and 
stables  are  its  favorite  haunts,  being  more  common  in  country  than 
in  city  districts,  and  feeding  voraciously  on  the  blood  of  horses  and 
cattle.  Its  puncture  is  not  poisonous,  and  is  less  painful  than  that 
of  the  mosquito.  Rosenau  and  others  believe  that  this  fly  can  con- 
vey and  inoculate  the  virus  of  poliomyelitis.  According  to  Austen 
and  Osborn  it  is  probably  also  capable  of  transmitting  trypanosomes, 
glanders  and  anthrax  from  infected  to  healthy  animals. 


FIG.    17. —  The    Biting   Stable-fly    (Stomoxys   calcitrans}.     Adult,    larva, 
puparium,  and  details,  all  enlarged.     (From  L.  O.  Howard.) 

Pollenia  rudis.  Cluster  fly.  A  little  larger  than  the  domestic  fly, 
with  dark-colored  smooth  abdomen  and  a  sprinkling  of  yellowish 
hairs.  A  sluggish  fly,  sometimes  abundant  in  spring  and  fall. 

Homalomyia  canicidaris.  Little  House-fly,  with  conical,  pointed 
body  and,  on  account  of  its  small  size,  often  mistaken  for  the  young 
of  the  common  fly.  Rather  frequently  seen  upon  window  panes  in 
houses. 

To  this  family  also  belongs  the  genus  Glossina,  the  Tse-tse  flies 


DISEASES  —  TRANSMITTING   ANIMALS.  157 

of  Africa,  with  dark-colored  body,  a  centimeter  long,  tnick,  project- 
ing proboscis  formed  for  blood  sucking,  and  a  wing  characterized  by 
the  cleaver-shaped  central  (or  discal)  cell.  When  at  rest  the  wings 
overlap,  crossing  each  other  like  the  blades  of  a  pair  of  scissors. 
G.  palpalis  is  the  common  transmitter  of  the  organism  of  sleeping 
sickness  in  Africa,  but  G.  morsitans,  G.  fusca  and  other  species  are 
also  believed  to  be  concerned  in  disseminating  this  disease. 

Family  Sarcophagidae.  Flesh  or  Blow  Flies,  with  shining  metal- 
colored  abdomen,  laying  their  eggs  on  meat  and  dead  animals  or 
even  in  wounds  and  open  cavities  of  living  animals. 

Calliphora  ery throe ebhala.  Large  Bluebottle  Fly,  with  black 
spines  on  the  striped  thorax.  Common  in  Europe  and  America. 

Phormia  terrcenovce.  Small  Bluebottle  Fly.  Widespread  in  the 
United  States.  Displays  a  conspicuous  dark  median  band  on  thorax 
and  abdomen. 

Chrysomyia  macellaria.  Screw-worm  Fly.  Another  quite  com- 
mon bluebottle  fly,  with  striped  thorax.  Sometimes  lays  its  eggs  in 
the  nostrils  of  man,  whence  the  maggots  may  gain  access  to  the 
frontal  sinus  or  other  cavity  and  do  serious  harm. 

Lucilia  cccsar.  Greenbottle  Fly.  Abundant  in  Europe  and 
America,  and  commonly  found  about  dead  animals.  Displays  the 
same  band  on  thorax  and  abdomen  as  the  small  bluebottle  fly. 

Sarcophaga  carnaria,  the  Flesh  Fly  of  Europe,  a  great  flesh  eater 
and  general  scavenger,  does  not  occur  in  the  United  States,  but  is 
replaced  by  similar  species  with  the  same  habits. 

Family  Sinmlidae.  Genus  Simnliiiin.  Wing  characterized  by 
having  only  2  or  3  veins.  Small  humpback,  biting  gnats  with  com- 
paratively stout  legs  and  short,  curved,  hairless  antennae. 

5".  reptans  has  been  accused  by  Sambon  of  being  the  trans- 
mitter of  the  germ  of  pellagra  in  Europe.  The  common  species  in 
the  United  States  are  5\  venustum,  or  "black  fly  "  of  the  northern 
woods,  and  5.  pecuarum,  the  southern  "  buffalo-gnat."  Other  south- 
ern species  are  5.  rittatmn  and  5.  pictipes.  The  part  played,  if  any. 
by  these  native  species  in  propagating  disease  has  not  yet  been  de- 
termined. 

Family  Tabanidae.  Horse-flies.  Wing  venation  strongly  marked, 
characterized  by  the  wide-open  mouth  of  the  apical  cell.  Known  to 
carry  disease  to  mammals,  and  believed  by  Austen  to  be  also  capable 
of  infecting-  man,  especially  in  tropical  countries. 


158  MILITARY    HYGIENE. 

Family  Psychodidae.  Moth-winged  Flies.  Wings  with  straight, 
nearly  parallel  veins  covered  with  hair-like  scales. 

Genus  Phlebotomus.  P.  papatasii,  the  propagator  of  papataci 
fever  in  the  Mediterranean  region  and  in  India,  is  a  very  small, 
stinging  insect,  passing  easily  through  the  usual  mosquito  net. 

Family  Culicidae.  Mosquitoes.  Wings  with  characteristic  vena- 
tion, their  apical  and  dorsal  margins  fringed,  and  the  veins  bearing 
small  scales ;  antennae  long,  bearing  whorls  of  hairs ;  mouth  parts 
forming  a  long  suctorial  beak  or  proboscis. 


CHAPTER   XIV. 
THE  MOSQUITO  AS  DISEASE  TRANSMITTER. 

Of  all  insects,  the  mosquito  is  preeminently  the  worst  enemy  of 
man,  for  not  only  does  it  disturb  and  irritate  him  with  its  sting,  but 
also  infects  him  with  the  germs  of  several  diseases.  It  is  known 
that  the  mosquito  is  the  chief  and  probably  exclusive  factor  in  the 
transmission  of  malaria,  yellow  fever,  dengue  and  filariasis,  and  sur- 
mised that  it  may  also  play  a  part  in  the  dissemination  of  other 
infectious  disorders. 

The  mosquito,  like  all  insects,  consists  of  a  head,  thorax  and 
abdomen,  with  a  pair  of  articulated  legs  attached  to  each  of  the 
three  segments  of  the  thorax.  Each  leg  comprises  femur,  tibia  and 
tarsus,  the  latter  piece  consisting  of  five  joints,  with  claws  on  the 
last  one.  Between  the  middle  or  main  segment  of  the  thorax  and 
the  posterior  segment  is  a  little  band  or  plate,  the  scutellum,  whose 
shape  and  scales  are  useful  in  classification.  The  head  consists 
chiefly  of  the  large  compound  eyes,  the  feelers  or  antennae,  and  the 
mouth  parts,  namely,  the  palpi  and  proboscis.  The  sexes  are  read- 
ily differentiated  by  the  antennae  which,  in  the  male,  bear  long  plume- 
like,  silky  hairs,  and,  in  the  female,  short,  scant  hairs.  (Fig.  23.) 
The  palpi  (mouth  feelers)  vary  in  length  according  to  sex  and 
species.  The  proboscis  (sting  or  beak)  consists  of  six  distinct 
piercing  elements,  or  stilets,  enclosed  and  protected  in  a  sheath  called 
labium.  This  sheath  does  not  penetrate  but  bends  backward  while 
the  stabbing  elements  are  thrust  into  the  animal  or  vegetable  from 
which  the  mosquito  seeks  food.  These  elements  form  a  tiny  channel 
along  which  the  blood  or  other  food  is  sucked  into  the  mouth  cavity. 

The  wing  venation  is  especially  important.  (Fig.  18.)  The  com- 
parative length  and  width  of  the  first  submarginal  cell  (between  forks 
of  second  vein)  and  the  second  posterior  cell  (between  forks  of 
fourth  vein),  as  well  as  the  position  of  the  cross  veins  which  deter- 
mines the  length  of  the  petiole  or  stalk  of  the  cells,  are  of  value  in 
differentiating  genera  and  species. 

Mosquitoes  feed  mostly  on  vegetable  juices,  the  male  exclusively 
so,  but  the  females  of  most  species,  when  the  opportunity  offers,  also 
suck  the  blood  of  mammals,  birds  and  other  animals.  The  male 

159 


l6o  MILITARY    HYGIENE. 

mosquito,  not  being  a  blood  sucker,  takes  no  part  in  the  propagation 
of  disease;  the  female  only  bites  and  infects  animals.  This  infec- 
tion takes  place  through  the  salivary  glands,  in  which  are  found 
the  malarial  germs  in  great  numbers.  While  the  female  sucks  blood, 


FIG.   18. —  Wing  of   Culex  mosquito.     A,  costa  or  marginal  vein;   B,  sub- 

costa  or  auxiliary  vein;  C,  first  submarginal  cell;  D,  second  posterior  cell; 

T,  first  long  vein;  2,  second  long  vein;  3,  third  long  vein;  4,  fourth  long 
vein;  5,  fifth  long  vein;  6,  sixth  long  vein. 

the  secretion  of  these  glands  is  ejected  into  the  tissues  of  the  bitten 
animal  through  the  salivary  duct  and  down  a  minute  canal  which 
opens  at  the  tip  of  one  of  the  stabbing  elements  of  the  proboscis. 
This  secretion  contains  also  an  irritant  poison  which  causes  the  smart 
and  swelling  of  the  sting.  The  function  of  this  poison  appears  to 
be  to  determine  a  flow  of  blood  to  the  bitten  part  and  prevent  its 
coagulation. 

The  mosquito  lays  its  eggs,  as  a  general  rule,  on  the  surface  of 
water,  but  this  water  must  be  still  or  stagnant ;  any  movement  from 
current,  tide  or  pumping  will  prevent  oviposition.  Occasionally,  as 
in  the  case  of  salt-marsh  species,  the  eggs  may  be  laid  on  mud  or 
even  the  dry  bottom  of  holes  and  depressions  likely  to  become  sub- 
merged.  The  eggs  are  glued  together  in  boat-shaped  masses  of 
several  hundreds,  a  quarter-inch  or  less  long  (Culex),  or  may  lie 
more  or  less  loosely  in  groups  of  a  few  scores  (Anopheles).  See 
Fig.  20.  They  hatch  in  a  couple  of  days,  giving  birth  to  the  larvre 
or  wigglers  which  at  once  exhibit  great  activity  in  feeding  them- 
selves. Being  air  breathers,  much  of  their  time  is  passed  at  the 
surface  of  the  water  with  the  breathing  tube  (near  the  tail)  protrud- 


THE    MOSQUITO    AS   DISEASE   TRANSMITTER. 


161 


ing  into  the  air.  (Figs.  21  and  22.)  After  undergoing  several 
moultings,  the  larva,  in  eight,  ten  or  more  days,  becomes  trans- 
formed into  the  pupa  which,  unless  disturbed,  quietly  floats  on  the 
surface  of  the  water.  In  about  two  days  the  pupa  case  bursts  and 
the  perfect  insect  emerges  from  it.  The  entire  period  elapsing  from 


FIG.  19. —  Dissection  of  head  of  mosquito :  A,  Median  section  of  head, 
showing  du,  the  veneno-salivary  duct,  with  its  insertion  in  hy,  the  hypo- 
pharynx  ;  cb,  cerebrum ;  below  this  are  the  cerebellum  and  the  pumping  en- 
largement of  ce,  the  oesophagus ;  in,  muscle ;  n,  nerve  commissure.  The  other 
parts  have  been  removed.  B,  the  veneno-salivary  duct,  showing  its  bifurca- 
tion and  the  three  glands  on  one  of  its  branches;  pg,  poison  gland;  sg, 
marks  the  upper  of  the  two  salivary  glands.  C,  the  bifurcation  of  the  duct 
with  its  nucleated  hypodermis.  (Manson.) 

the  laying  of  eggs  to  the  birth  of  the  full-fledged  mosquito  occupies 
from  8  or  10  days  to  3  or  4  weeks,  according  to  species  and  also  to 
climate  and  temperature,  the  process  being  particularly  active  in 
hot,  damp  weather.  The  same  female  may  lay  eggs  several  times 
and  become  the  ancestor  of  many  successive  generations  during  the 
summer.  Few  males  outlive  the  summer.  In  a  few  species,  nota- 
bly the  house  mosquitoes  (Culex  pipiens  and  C.  quinquefasciatus}, 
the  malarial  mosquito  (Anopheles  maculipennis}  and  the  yellow 
fever  mosquito,  the  impregnated  females  hibernate  in  sheltered 
places,  ready  to  lay  eggs  as  soon  as  the  temperature  permits  in 


1 62 


MILITARY    HYGIENE. 


the  spring.  But  in  most  species,  such  as  the  salt  marsh,  woodland 
and  prairie  mosquitoes,  males  and  females  are  killed  by  the  first 
frost  of  winter.  These  species  hibernate  mostly  in  the  egg  stage. 
The  egg  is  known  to  be  endowed  with  astonishing  vitality, 
remaining  unaffected  by  the  intense  winter  cold  of  the  northern 
States.  Thus,  as  observed  by  Dr.  J.  B.  Smith,  the  eggs  of  the  salt- 
marsh  species  may  remain  in  dried  water  holes  for  at  least  two 
years  without  deteriorating,  and  will  promptly  hatch  if  covered 
with  water  during  the  third  year.  Larvae  may  also  pass  the  winter 
in  ice  without  being  killed,  reviving  as  the  ice  melts  and  then 
developing  into  perfect  insects.  But  they  require  water  for  their 
development;  if  the  pool  in  which  they  are  hatched  dries  up  within 
a  week,  or  before  their  transformation  is  completed,  they  soon 
perish,  especially  if  exposed  to  the  sun. 

In  tropical  countries,  mosquitoes  breed  throughout  the  year, 
except  during  the  dry  season,  when  the  female  remains  inactive, 
waiting  for  a  rainy  spell.  It  has  been  noted  that  eggs  laid  in  water 


FIG.  20. —  Mosquito  eggs,  (i),  Egg-t>oat  of  Culex  seen  from  above;  (2), 
the  same,  side  view;  (3),  separate  Culex  eggs;  (4),  eggs  of  Panoplites;  (5), 
eggs  of  Stegomyia;  (6),  the  same,  more  magnified;  (7),  group  of  Anopheles 
eggs;  (8)  and  (9),  eggs  of  Anopheles  maculipennis,  showing  lateral  floats. 


THE    MOSQUITO    AS   DISEASE   TRANSMITTER.  163 

which  dries  up  before  they  hatch  may  retain  their  vitality  for  a 
number  of  weeks. 

The  female  sucks  blood  in  order  to  obtain  suitable  nutriment  for 
the  ripening  of  her  eggs,  and  it  is  after  such  a  meal  that  she  ovi- 
posits. As  the  blood  ingested  considerably  increases  her  weight 
and  bulk,  making  her  flight  slow  and  laborious,  she  lights  on  any 
suitable  water  nearest  at  hand. 

Although,  when  scenting  a  prey,  it  is  persistent  in  pursuing  it, 
the  mosquito  does  not  usually  take  long  flights,  seldom  straying  far 
from  its  breeding  place.  In  a  town,  each  square  or  street  is  gener- 
ally responsible  for  the  mosquitoes  that  plague  it.  In  the  absence 
of  water  near  by,  mosquitoes  will  fly  short  distances  in  search  of 
suitable  places  to  lay  their  eggs ;  or  where  they  breed  in  crowding 
swarms,  the  instinct  of  self-preservation  leads  them  to  allow  them- 
selves to  be  carried  away  by  the  breeze.  The  salt-marsh  mosquitoes, 
for  instance,  (C.cantator,C.sollicitans,etc.)  have  decidedly  unpleas- 
ant migratory  habits,  although  seldom  breeding  outside  of  salt 
or  brackish  water.  Governor's  Island,  in  the  bay  of  New  York,  is 
periodically  infested  with  swarms  of  mosquitoes  in  summer;  careful 
inspection  has  failed  to  discover  any  breeding  place  on  the  island, 
and  as  they  appear  with  easterly  winds  the  inference  is  justified  that 


FIG.  21. —  Larvae  and  pupa  of  Culex.     Note  the  breathing  tube. 

they  are  blown  from  Long  Island,  probably  a  distance  of  several 
miles.  As  a  general  rule,  however,  as  soon  as  the  wind  begins  to 
blow,  mosquitoes  seek  shelter  in  the  grass  and  in  the  lee  of  shrubs 
and  trees.  It  must  be  borne  in  mind  that  they  are  readily  trans- 
ported to  distant  places  by  ordinary  vehicles  of  communication,  such 


164 


MILITARY    HYGIENE. 


as  ships,  trains,  carriages  etc.,  so  that  they  may  suddenly  appear 
where  they  have  never  been  known  before,  or  reappear  where  they 
have  not  been  seen  for  many  years. 

Isolated  mosquitoes  may  exceptionally  appear,   one  or   few,   in 
unexpected  places  and  soon  again  disappear,  but,  as  a  general  rule, 


FIG.  22. —  Larva  and  pupa  of  Anopheles.     Note  shortness  of  breathing  tube, 
compelling  the  larva  to  hold  its  body  parallel  with  the  surface. 

their  constant  presence  anywhere  -indicates  that  they  are  bred  in 
some  neighboring  marsh  or  pond  on  a  large  scale,  or  else  in  holes, 
cisterns,  barrels  or  gutters,  freely  exposed,  for  unless  they  have 
favorable  recruiting  grounds  they  soon  become  extinct. 


CLASSIFICATION  AND  DESCRIPTION   OF   DISEASE-BEARING 

MOSQUITOES. 

The  following  subfamilies,  genera  and  species  include  all  mos- 
quitoes   known,    or    reasonably    suspected,    to    transmit    disease. 


Anopheles  Culex. 

FIG.  23. — -Heads  of  mosquitoes  showing  the  difference  between   Culex  and 
Anopheles  in  both  sexes   (Giles). 

Apparent   similarity   of   structure   between   allied   species   may   not 
necessarily  imply  the  same  pathogenic  capability,  but  with  our- still 


THE    MOSQUITO    AS    DISEASE   TRANSMITTER. 


very  incomplete  knowledge  of  the  subject  it  seems  logical  and  safer 
to  consider  such  similarity  a  reason  for  suspicion.* 

A.  Subfamily  Culicinae-t  —  Scutellum  trilobed.  Palpi  short  in 
female,  long  in  male;  first  submarginal  cell  as  long  as  or  longer 
than  the  second  posterior  cell. 

i.  Culex.  —  "  Head  ornamented  with  narrow  curved  scales  over 
the  occiput,  and  upright  forked  scales,  especially  thick  on  the  back 


_, 


FIG.  24. —  Culex  fatigans,  female.     (Litdlow.} 

of  the  head;  flat  scales  on  the  sides."  Wings  with  small  median 
scales,  and  thin  linear  lateral  ones,  to  the  veins. —  Large  and 
unwieldly  genus  of  which  C.  pipiens,  the  common  European  mos- 
quito, is  the  type.  It  is  remarkable  that  of  the  numerous  species  of 
Culex,  only  one  is  positively  known  to  be  disease-bearing. 

C.  fatigans  (C.  pungens,  C.  quinquefasciatns). —  Thorax  clothed 

*  For  much  of  this  information,  I  am  indebted  to  Bull.  No.  4,  Surgeon 
General's  office,  by  C.  S.  Ludlow,  Ph.  D. 

t  The  nomenclature  of  North  American  mosquitoes  being  still  in  course  of 
revision  and  elaboration,  it  was  deemed  best,  in  this  edition,  to  retain  the 
previous  familiar  names  rather  than  adopt  recent  changes  which  may  need 
further  modifications  when  the  classification  has  been  finally  settled. 


1 66  MILITARY    HYGIENE. 

with  golden  scales  and  three  lines  of  black  bristles ;  petiole  of  first 
submarginal  cell  *4  or  more  the  length  of  the  cell;  abdominal  seg- 
ments nearly  black,  with  straw-colored  bands;  legs  generally  dark 
brown.  (Fig.  24.)  Found  throughout  all  the  warmer  parts  of  the 
world,  as  a  purely  domestic  species,  with  the  same  general  distribu- 
tion as  Stegomyia  fasciata.  This  Culex  is  the  intermediary  host  of 
Filaria  bancrofti  and  probably  of  F.  philippinensis  which  it  transmits 
to  man.  It  seems  to  be  also  the  chief  factor  in  the  transmission  of 
dengue. 

North  of  Washington,  C.  fatigans  is  replaced  by  the  closely  allied 
C.  pipiens,  introduced  from  Europe,  and  the  common  "  house  mos- 
quito "  of  the  northern  Atlantic  States  and  Canada.  Like  fatigans, 
it  is  nearly  uniformly  dark-yellowish,  with  light-colored  bands  at 
base  of  the  abdominal  segments,  but  characterized  by  the  very  short 
petiole  of  the  first  submarginal  cell,  not  more  than  one-sixth  the 
length  of  the  cell.  It  winters,  by  preference,  in  cellars  or  other 
damp  and  dark  shelters  in  or  near  houses.  The  female  lays  her 
eggs  (about  200),  glued  together  in  the  shape  of  a  raft,  on  any  kind 
of  water,  however  foul,  from  rain  barrels  to  catch  basins  and  cess- 
pools. This  mosquito  persistently  strives  to  get  into  dwellings,  not 
only  by  open  doors  and  windows,  but  also  by  forcing  its  way  through 
the  meshes  of  nettings.  It  does  not  usually  travel  much,  seldom 
more  than  a  few  hundred  yards  from  the  place  of  its  birth. 

2.  Stegomyia.  —  Head  scales  all  flat  and  broad.  Abdomen  com- 
pletely covered  with  flat  scales.  Wings  with  small  scales,  both 
spatulate  and  linear.  Mostly  jet-black  insects  with  ornamental  lines 
of  silvery  scales  on  thorax  and  legs.  —  A  genus  of  some  19  species, 
all  with  a  smooth  satiny  appearance. 

S.  fasciata  (S.  calopus.}.  —  Thorax  velvety-black  to  golden- 
brown,  marked  with  two  median  straight  and  lateral  curved  lines, 
in  the  form  of  a  lyre  (or  Jew's  harp).  Abdominal  segments  with 
snowy- white  bands  and  lateral  tufts.  Proboscis  pure  black.  Legs 
prettily  banded.  (Fig.  25.) 

This  is  the  most  widely  distributed  mosquito  of  the  family,  being 
found  throughout  the  entire  tropical  and  subtropical  zones,  from 
the  Hawaiian  Islands  to  the  Philippines,  India,  Egypt,  Italy,  Spain, 
the  West  Indies,  Central  and  South  America,  and  our  southern 
States  as  far  north  as  Virginia.  Although  of  domestic  habits  and 
breeding  freely  in  cisterns  and  tanks,  it  is  also  a  good  traveller  on 


THE    MOSQUITO    AS   DISEASE    TRANSMITTER. 


167 


steamers,  and  may  be  expected  to  establish  itself  in  any  moist  trop- 
ical zone,  a  fact  which  should  be  borne  in  mind  when  much  of  our 
Asiatic  trade  passes  through  the  Isthmus  of  Panama.  It  is  the  only 
known  agent  of  transmission  of  yellow  fever.  That  it  is  the  only 
one  cannot  be  asserted  and  does  not  seem  probable,  but  it  is  a  prac- 
tical fact  that  campaigns  against  yellow  fever  based  on  that  assump- 
tion have  always  been  successful. 


FIG.  25. —  Stegomyia  fasciata   (S.  calopus}. 

S.  scutellaris  of  India,  Siam  and  the  Philippine  Islands  is  very 
much  like  the  preceding,  but  with  only  one  median  line  and  no 
curved  outer  line  on  the  thorax. 

The  larvae  of  Filaria  are  said  to  occur  in  these  two  species  of1 
mosquitoes,  but  unable  to  reach  maturity. 

5.  persistans  Banks,  from  the  Philippines,  is  only  a  common  form 
of  fasciata. 

3.  Mansonia.  —  Wings  with  large,  broad  and  asymmetrical  scales. 

M.  uniformis.  —  Thorax   chestnut-brown.      Wings   brindled  but 


1 68  MILITARY    HYGIENE. 

unspotted.  Legs  mottled  and  banded.  Proboscis  with  broad  yel- 
lowish band.  —  India,  Africa  and  the  Philippine  Islands.  This,  and 
M.  pseudotitillans  of  Brazil,  are  hosts  of  Filaria. 

B.  Subfamily  Anophelinae.  —  Soberly  tinted  insects,  with  palpi  of 
about  the  same  length  as  the  proboscis  in  both  sexes,  usually  clubbed 
in  the  male.  Scutellum  simple,  never  trilobed.  In  this  subfamily 
are  found  all  the  mosquitoes  concerned  in  the  transmission  of 
malaria.  Anopheles  is  the  only  genus  in  this  country,  but  the  other 
genera  here  described  occur  in  our  colonies.  Of  the  15  or  more 
species  of  Anophelinae  found  in  the  Philippine  Islands,  4  have  been 
proved  to  be  hosts  of  the  malarial  parasite  and  responsible  for  most 
of  the  malarial  fever  there,  while  at  least  three  other  species  are 
open  to  suspicion. 

i.  Anopheles.  —  "Thorax  and  abdomen  hairy.  Palpi  of  females 
thin,  generally  unbanded.  Wing  veins  with  long  lanceolate  scales 
which  may  or  may  not  form  tufts,  but  rarely  showing  much  color- 
spotting.  Mostly  large  species  from  temperate  or  mountain  cli- 
mates." Feet  wholly  black.  —  Represented  in  the  United  States  by 
9  or  more  species.  Of  the  malarial  mosquitoes  of  the  Philippines 
and  West  Indies  none  belong  to  this  genus. 

The  Anopheles  is  readily  distinguished  from  Culex  by  the  long 
palpi  of  the  female  which  produce  the  appearance  of  three  probosces. 
Its  attitude  when  at  rest  is  also  characteristic,  with  body  in  a  straight 
line  but  at  an  angle  with  the  resting  surface,  head  down  and  tail 
up,  while  the  Culex,  although  more  humpbacked,  holds  its  body 
nearly  parallel  with  the  resting  surface.  The  Anopheles  lays  only 
40  to  100  eggs,  more  or  less  separated  and  not  attached  together 
like  those  of  Culex.  The  eggs  of  the  maculipennis  are  characterized 
by  fine  reticulate  hexagonal  sculpturing.  The  larvae  (wigglers)  of 
both  genera  are  also  readily  distinguished;  that  of  Culex  projects  its 
long  breathing  tube  through  the  water  surface  and  holds  its  body 
downward  at  an  angle,  while  that  of  Anopheles  has  short  breathing 
tube  and  holds  its  body  parallel  with  the  surface.  The  entire  period 
covered  by  the  metamorphosis  of  the  maculipennis,  from  the  laying 
of  the  egg  to  the  escape  of  the  insect,  ranges  between '12  to  20  days, 
being  somewhat  longer  than  that  of  our  common  Culex  pipiens  and 
fatigans.  The  Anopheles  is  more  particular  as  to  breeding  places 
than  Culex,  generally  preferring  clear  water  containing  green  algae 
and  other  aquatic  plants. 


THE    MOSQUITO    AS   DISEASE   TRANSMITTER. 


169 


The  following-  are  our  noteworthy  species : 

A.  maculipennis  (Fig.  26). —  Rather  large  but  inconspicuous; 
easily  recognized  by  the  four  small  black  spots  on  the  wings,  and  the 
wholly  black  margin  and  veins.  In  the  female  the  palpi  are  yellow- 
ish-brown, with  dense  dark  scales  at  the  swollen  base,  and  shorter 
than  the  proboscis.  Found  almost  everywhere  in  North  America  and 
Europe,  and  the  common  malarial  mosquito  of  both  continents. 
Also  found  to  be  a  host  of  the  Leishmania  parasite  in  all  stages  of 
development  by  Franchini.  Shy  and  difficult  to  secure,  even  when 
not  rare. 


FIG.  26. 


FIG.  27. 


FIG.  26. —  Anopheles  maculipennis,  female.     (Ludlo-w.) 

FIG.  27. —  Anopheles  punctipennis,  female,  with  male  antenna  at  right  and 
wing  tip  showing  venation  at  left;  much  enlarged.  (Hoii'ard.) 

A.  punctipennis  (Fig.  27). —  Handsome  insect  with  two  brilliant 
yellow  spots  on  margin  of  the  dark  wing,  one  near  the  apex,  the 
other  larger,  above  the  middle.  More  than  five  black  spots  on  the 
veins.  Base  and  tip  of  last  vein  black,  remainder  white.  Very 
common  in  this  countrv  and  Canada. 


I/O 


MILITARY    HYGIENE. 


The  experiments  of  Dupree*  and  Mitzmain,  P.  H.  S.,  have  shown 
that  it  may  become  infected  with  the  parasite  of  tertian  malaria  and 
transmit  it.  It  is  infrequently  found  in  human  habitations  and 
therefore  probably  of  little  importance  in  the  spread  of  malaria. 
Said  to  breed  along  rapidly  moving  water-courses. 

A.  pseud opunctipennis.  —  Characterized  by  having  the  3d,  4th 
and  last  veins  white,  patched  with  black.  Said  by  Darling  to  be 
"  only  slightly  concerned  in  the  transmission  of  malarial  fever  "  on 
the  Isthmus  of  Panama. 


i 


FIG.  28. —  Anopheles  crucians,   female.     (Ludlow.) 

A.  franciscanus.  —  Much  like  pseudopunctipennis  and  believed 
by  Knab  to  be  identical  with  it;  the  dark  costa  (edge)  of  the  wing 
with  two  nearly  equal  yellow  spots.  Basal  half  of  last  vein  white, 


The  New  Orleans  Med.  and  Surg.  Journal.    January,  1902,  and  July,  1905. 


THE    MOSQUITO    AS    DISEASE    TRANSMITTER.  17! 

remainder  black.     Found  from  California  to  Texas  and  Louisiana, 
and  strongly  suspected  of  conveying  the  malarial  parasite. 

A.  crucians  (Fig.  28).  —  Front  margin  of  the  wing  wholly  black. 
The  last  vein  white,  with  three  black  spots.  Tawny,  the  thorax 
with  three  deeper  tinted  lines.  Often  seen  in  tidal  waters.  South- 
ern States  to  California.  Claimed  by  Pothier  and  Beyer  to  become 
infected  with  the  parasite  of  estivo-autumnal  fever,  and  by  Mitz- 
main  by  the  parasites  of  both  tertian  and  estivo-antumnal  malaria. 
Like  punctipennis,  it  is  seldom  found  in  human  habitations. 

2.  Cycloleppteron.  —  Wing  with  lanceolate  scales,  and  patches  of 
large  inflated  scales,  densely  pigmented,  of  almost  circular  outline. 

C.  grabhamii.  —  Small  dark  mosquito  with  black  dot  on  each  side 
of  thorax,  yellow  patches  on  wings  and  brindled  legs ;  palpi  very 
hirsute,  almost  to  the  tips.  West  Indian  Islands,  where  it  has  been 
found  to  convey  malaria. 

3.  Myzomyia.  —  Thorax  and  abdomen  hairy.     Wings  with  long 
narrow  scales  projecting  far  apart;  more  or  less  spotted  in  con- 
trasted colors.     Feet  with  white  bands. 

M.  fimesta  (Anopheles  funestns)  (Fig.  29).  —  Small  dark  mos- 
quito, with  three  yellow  spots  on  the  intensely  black  costa  (edge  of 
wing),  and  spotted  wing  fringe;  palpi  with  white  tip  and  two  snowy 
bands.  —  A  host  of  the  malarial  parasite  in  Africa,  and  always  taken 
in  the  Philippines  wherever  malaria  is  prevalent,  so  as  to  leave  no 
doubt  of  its  guilt. 

M.  rossii  (A.  rossii). —  A  common  species  of  India,  where  it 
transmits  filaria ;  also  considered  the  malarial  carrier  in  Ceylon ;  but 
too  rare  in  the  Philippines  to  be  of  importance. 

M.  Indloivii. —  Small,  with  banded  palpi  and  white-tipped  pro- 
boscis ;  legs  mottled  and  spotted  with  yellow ;  wings  with  4  large 
costal  spots  and  one  or  two  small  basal  ones.  —  One  of  the  few  mos- 
quitoes breeding  indifferently  in  fresh  and  salt  water,  being  mostly 
found  in  tidal  back  waters.  Widely  distributed  in  the  Philippines 
where  it  appears  coincidently  with  malaria  and,  according  to  Banks 
and  other  observers,  positively  connected  with  its  transmission. 

M.  indefinita.  —  Very  closely  related  to  the  preceding  two  species, 
but  without  the  leg  spots  of  ludlozvii.  Also  quite  common  in  the 
Philippines,  but  its  connection  with  malaria  still  doubtful. 

Several  other  species  of  Myzomyia  have  been  found  carriers  of 
the  malarial  parasite  in  India,  and  one  in  Brazil. 


172 


MILITARY    HYGIENE. 


FIG.  29. 


FIG.  30. 


FIG.  29. —  Myzomyia  funesta   (Anopheles  funestus)    female.     (Ludlow.) 
FIG.  30. —  Myzorhynchus  barbirostris   (Anopheles  barbirostris). 

4.  Myzorhynchus.  —  Abdomen  without  lateral  scale  tufts;    wing 
scales  broadly  lanceolate,  sometimes  short  and  broad ;  palpi  and  pro- 
boscis bushy  with  densely  packed  scales. 

M.  barbirostris  (Anopheles  barbirostris)  (Fig.  30).  —  Dark  in- 
sect ;  wing  intensely  black,  with  many  small  spots ;  head  and  ap- 
pendages entirely  black  except  a  white  frontal  tuft.  —  A  host  of  the 
malarial  parasite  in  India,  and  found  in  the  Philippines  coincidently 
with  malarial  fever. 

M.  pseudobarbirostris,  an  allied  species,  may  also  be  suspected. 

M.  sinensis,  a  host  of  the  malarial  and  filarial  parasites  in  Japan 
and  China,  has  been  found  at  some  of  the  stations  in  the  Philippine 
Islands,  but  its  connection  with  malaria  there  is  still  doubtful. 

Several  other  African  and  Indian  species  are  also  known  agents 
of  malarial  and  filarial  infection. 

5.  Nyssorhynchus.  —  Thorax  with  narrow,  curved  and  fusiform 
scales.     Abdomen  with  lateral  tufts  and  dorsal  patches  of  flat  scales. 
Palpi  densely  scaly.     Legs  banded  and  spotted  white. 


Till-:    MOSQUITO    AS    DISEASE    TRANSMITTER. 


1/3 


N.  fuliginosus  (Anopheles  fuliginosus). —  Small,  very  dark  mos- 
quito, with  three  yellowish  spots  on  the  black  costa  and  numerous 
black  dots  on  the  veins,  the  last  three  tarsal  joints  of  hind  legs  pure 
white.  —  Always  appears  in  the  Philippines  in  connection  with 
malarial  outbreaks  and  may  be  regarded  as  one  of  the  transmitters 
of  the  parasite. 


FIG.   31. —  Cellia   albimana,    female.     (Ludlow.} 

6.  Cellia.  —  Abdomen  almost  completely  but  irregularly  densely 
scaly,  with  large  lateral  tufts.  —  Handsome  insects,  among  which 
are  the  best-known  malarial  carriers  of  the  West  Indies  and  Panama. 

C.  albimana  (Anopheles  albipes,  A.  cubensis). —  Dark  mosquito 
with  the  last  three  hind  tarsal  joints,  and  nearly  half  the  second, 
pure  white,  save  for  a  black  band  at  base  of  the  terminal  joint. 
(Fig.  31.) — "Certainly  much  the  commonest  Central  American 
and  West  Indian  anopheline,  said  to  breed  in  canals,  puddles,  and 
in  the  most  varied  situations,  even  in  brackish  water"  (Giles).  It 
bites  severely  at  any  time  of  day  and  night.  One  of  the  usual  hosts 
for  the  parasite  of  malignant  malaria,  and  of  Filaria  bancrofti.  It 


MILITARY    HYGIENE. 

is  inefficient  for  Filaria  demarquaii.  According  to  Darling,  by  far 
the  most  abundant  mosquito  on  the  Isthmus  of  Panama,  a  host  for 
the  estivo-autumnal  as  well  as  the  tertian  and  quartan  parasites. 

C.  argyrotarsis  (Anopheles  argyrotarsis} . —  Much  like  the  pre- 
ceding but  not  so  dark,  and  without  the  black  band  at  base  of  ter- 
minal tarsal  joint.  Also  common  in  all  the  West  Indies  and  further 
south,  and  likewise  an  efficient  host  and  transmitter  of  malarial 
parasites. 

Another  species  is  a  common  agent  of  malarial  infection  in  Africa. 

DESTRUCTION  OF  MOSQUITOES. 

As  with  flies,  much  can  be  done  during  the  winter  when  many  of 
the  surviving  mosquitoes,  including  house  species  as  well  as  the 
malarial  and  yellow-fever  species,  can  be  found  in  cellars,  base- 
ments, stables,  barns,  outhouses,  etc.,  in  sheltered  places.  These 
hibernating  mosquitoes  are  the  most  dangerous  from  the  fact  that 
they  are  all  females,  most  of  them  impregnated  and  ready  to  ovi- 
posit in  the  spring.  Each  one  killed  is  equivalent  to  the  suppres- 
sion of  thousands  in  the  following  summer.  Many  can  be  destroyed 
by  cautiously  holding  under  them  a  small  vessel  containing  a  little 
ammonia,  petroleum,  spirits  of  turpentine  or  cotton  moistened  with 
chloroform.  A  small  tin  can  nailed  through  the  bottom  to  the  end 
of  a  stick  forms  a  convenient  receptacle  for  the  purpose.  It  is  held 
a  moment  against  the  ceiling  so  as  to  prevent  the  escape  of  the 
insects. 

Whenever  a  building  or  room  has  become  invaded  by  mosquitoes, 
especially  if  there  is  reason  to  believe  that  it  contains  infected  ones, 
the  most  effective  way  to  get  rid  of  them  is  by  fumigation,  as  de- 
scribed under  Insecticides. 

Hand-catching  with  a  chloroform  'bottle,  the  use  of  "  slappers  " 
made  of  wire  gauze,  and  of  traps,  are  all  useful  measures  to  get  rid 
of  indoor  mosquitoes,  especially  in  the  tropics.  Anopheles  are 
mostly  found  in  early  morning  and  in  the  dusk  of  the  evening  on 
the  inside  and  outside  of  the  screens,  seldom  more  than  six  feet 
from  the  floor,  and  in  that  situation  are  easily  killed  by  slappers. 

Mosquitoes  cannot  breed  unless  there  is  water  wherein  the  eggs 
may  hatch  and  the  larvae  develop.  Hence  the  accepted  axiom :  no 
water,  no  mosquitoes.  This  water  must  be  relatively  still ;  no  run- 
ning or  ruffled  water  will  do.  The  first  measure  then  that  im- 


THE    MOSQUITO   AS    DISEASE   TRANSMITTER.  175 

poses  itself  is  the  drainage  or  filling  of  all  surrounding  swamps  and 
stagnant  pools.  In  marshy  lands  the  breeding  places  are  mostly 
near  the  edges,  along  the  uplands,  and  such  places  should  prefer- 
ably be  filled  up.  In  tidal  marshes,  narrow  ditches  20  to  30  inches 
deep,  dug  at  intervals  of  100  to  150  feet,  will  drain  all  intervening 
pools,  with  the  addition  of  an  occasional  spur  ditch.  Creeks, 
ditches  and  pools  in  which  the  water  rises  and  falls  with  the  tides 
will  not  breed  mosquitoes;  therefore  if  a  pool  cannot  be  emptied, 
it  should,  if  possible,  be  connected  with  a  tidal  creek.  Another 
method  to  prevent  breeding  in  a  marshy  area  which  cannot  be 
drained  is  to  dig  a  pit  at  its  lowest  point  so  as  to  form  a  catch  basin 
into  which  all  surrounding  stagnant  waters  will  gravitate,  and  then 
stock  it  with  fish. 

In  the  tropics,  open  ditches  soon  become  obstructed  with  vegeta- 
tion and  are  often  breeding  places ;  there,  buried  tile  drains  are 
effective  and  economical ;  where  they  cannot  be  used,  open  concreted 
ditches  are  best. 

In  conjunction  with  drainage  and  filling,  another  important 
measure  is  the  removal  of  shelters,  such  as  thick  underbrush,  long 
grass  and  thrifty  weeds,  especially  along  streams  and  on  border  of 
ponds,  which  afford  protection  to  mosquitoes  and  prevent  the  drying 
of  water  holes. 

Within  the  boundaries  of  a  post  or  camp,  swarms  of  mosquitoes 
may  be  produced  from  sewers,  cisterns,  tanks,  pits  and  cesspools, 
water  barrels,  neglected  buckets  and  tin  cans.  Therefore,  before 
blaming  the  neighboring  grounds  it  is  always  judicious  to  make  a 
careful  investigation  of  the  military  reservation  and  exclude  there- 
from all  possible  breeding  places.  Pits  and  holes  should  be  filled  up. 
All  receptacles  likely  to  hold  rain-water  should  be  broken  up  or 
turned  'bottom  up.  Barrels  and  cans  in  which  water  must  be  kept 
should  be  covered  with  a  well-fitting  lid.  Tanks  and  cisterns,  if  not 
roofed  over  and  mosquito-tight,  should  be  protected  with  wire 
screens.  Pools  and  ponds  which  cannot  be  drained  or  filled  up 
should  have  a  thin  film  of  kerosene  or  petroleum  poured  upon  the 
surface,  or  sprayed  with  a  nozzle,  at  the  rate  of  one  ounce  to  each 
15  square  feet,  once  every  two  weeks,  or  whenever  necessary;  if 
washed  away  by  heavy  rains  or  blown  against  the  shore  by  high 
winds,  more  frequent  applications  should  be  made.  This  "  petrol- 
ization  "  is  easy,  cheap  and  quite  effective ;  not  only  does  the  film 


1^6  MILITARY    HYGIENE. 

of  oil  prevent  the  female  mosquito  from  laying  eggs,  but  all  the 
larvae  already  in  the  water,  unable  to  breathe  through  it,  promptly 
perish.  The  best  oil  for  the  purpose  is  one  which  spreads  readily 
but  does  not  evaporate  too  rapidly,  the  crude  oil  or  fuel  oil  of  trade. 
The  addition  of  crude  carbolic  acid  renders  it  more  diffusible  and 
efficient. 

There  are  situations  in  which  petroleum  is  not  satisfactory, 
especially  in  the  tropics  where  the  vegetation  is  rank  and  pouring 
rains  frequent.  It  must  also  be  borne  in  mind  that  if  it  kills 
larvae  it  is  likewise  dangerous  to  fish  and  other  useful  aquatic 
animals.  Therefore  efforts  have  been  made  to  discover  a  more  suit- 
able larvicide,  that  is  to  say,  a  cheap  substance  which  will  thoroughly 
diffuse  in  the  water,  kill  the  larvae  promptly  as  well  as  green  algae, 
and  remain  efficient  for  some  days  without  being  poisonous  to  man, 
domestic  animals  and  fish.  Of  the  several  proprietary  mixtures 
found  in  the  market  none  seems  entirely  satisfactory.  Certain  ani- 
line products  have  been  recommended  by  Celli.  "  Phinetas  oil  " 
has  been  more  or  less  used  on  the  Isthmus  of  Panama,  especially 
along  borders  of  swamps  and  streams.  It  forms  a  milky  compound 
with  water  which  destroys  not  only  larvae  but  all  other  animal  life. 
It  varies  in  quality  and  loses  its  efficiency  very  soon  after  applica- 
tion. The  department  of  sanitation  of  the  Canal  Zone  has  devised 
a  cheap  larvicide  which  gives  excellent  results,  although  not  sup- 
planting petroleum  in  suitable  places.  It  is  prepared  as  follows: 
150  gallons  of  crude  carbolic  acid  are  heated  in  a  tank  to  a  tem- 
perature of  212°  F. ;  200  pounds  of  powdered  and  sifted  resin  are 
then  poured  in,  followed  by  30  pounds  of  caustic  soda  previously 
dissolved  in  6  gallons  of  water,  the  mixture  being  kept  at  212°  and 
thoroughly  stirred  until  a  perfectly  dark  emulsion,  without  sedi- 
ment, is  obtained.  One  part  to  5,000  parts  of  water  will  kill  larvae 
in  5  to  10  minutes.  It  has  also  high  value  as  a  germicide  and  algi- 
cide,  thus  destroying  the  food  and  hiding  places  of  the  larvae.  It 
is  used  by  spraying  it,  diluted  with  water  (i  to  5),  over  the  surface 
and  along  the  margins  of  mosquito-breeding  places. 

Ponds  and  lakes  will  be  sufficiently  protected  if  well  stocked  with 
fish.  The  best  kinds  for  this  purpose,  in  the  United  States  (ac- 
cording to  W.  P.  Seal,  a  recognized  authority  on  the  subject),  are 
a  combination  of  goldfish,  roach  (Leuciscus*)  and  top-minnows 
(Gambusia  affinis  and  Heterandria  formosa)  which  feed  near  the 


THE    MOSQUITO    AS   DISEASES   TRANSMITTER.  177 

surface  and  almost  entirely  upon  insect  larvae.  Also  very  useful 
are  several  species  of  Fundulus,  the  killies,  in  their  natural  habitat 
in  tidal  streams  and  salt  marshes.  On  account  of  their  predaceous 
habits  it  is  doubtful  whether  they  would  be  desirable  in  land-locked 
waters.  Two  small  species  of  sunfish  (Enneacanthus)  are  also 
recommended.  In  Cuba,  the  guayacones,  species  of  Gatnbusia, 
especially  G.  punctata  which  is  the  most  common,  have  been  suc- 
cessfully used  to  get  rid  of  mosquito  larvae.  The  sticklebacks  have 
been  mentioned  in  this  connection  but,  being  bottom  feeders,  are 
undoubtedly  useless  for  the  purpose. 

Certain  water  plants  grow  rapidly  upon  the  surface  of  water, 
forming  a  thin  floating  mantle  which  interferes  with  the  breeding 
of  mosquitoes.  Species  of  Azolla  have  been  recommended;  the 
common  American  form  does  not  spread  much  and  is  of  little  value  ; 
a  Pacific  form,  often  covering  extensive  stretches  of  quiet  water 
with  a  dense  purple-red  mantle,  is  more  promising  for  mild  climates  ; 
the  European  form  which  covers  many  of  the  canals  in  Holland  is 
also  worthy  of  trial  in  fresh  water.  Our  duckweeds  (Lemma) 
may  be  useful  in  certain  situations,  although  they  do  not  begin  to 
expand  much  until  summer. 

Various  trees  and  shrubs  have  been  extolled  as  effective  agents  for 
repelling  and  killing  mosquitoes  through  their  peculiar  emanations, 
especially  certain  species  of  Eucalyptus,  the  castor-oil  plant,  the 
china-berry  tree  and  the  papaw ;  but  more  trustworthy  observations 
have  demonstrated  their  absolute  worthlessness  for  the  purpose. 


CHAPTER  XV. 
INSECTICIDES. 

Substances  generally  used,  by  combustion  or  in  gaseous  form,  for 
the  destruction  of  flies,  mosquitoes,  fleas,  lice,  bedbugs,  roaches  and 
other  obnoxious  insects.  Some  are  also  effective  against  rats  and 
mice.  All  possess  more  or  less  germicidal  properties,  as  described 
under  Disinfectants.  In  using  them,  the  rooms  should  be  made 
reasonably  tight  by  pasting  strips  over  the  big  cracks,  which  also 
prevent  the  escape  of  the  insects.  Closets,  cases,  drawers,  etc., 
likely  to  harbor  the  latter,  should  be  opened  to  allow  free  access  of 
the  gas  or  fumes.  Anything  that  will  make  a  dense  smoke  in  burn- 
ing will  kill  or  drive  away  mosquitoes  and  flies,  but  the  following 
substances  are  those  most  commonly  used  as  insecticides : 

Pyrethrum  insect  powder.  —  Made  from  the  dried  flower-heads 
of  several  species  of  Pyrethrum  and  owes  its  power  to  a  volatile 
oil  that  disappears  with  age  and  exposure.  If  burned  in  an  open 
room,  mosquitoes  and  flies  are  temporarily  driven  out.  In  a  closed 
room,  in  the  proportion  of  4  to  6  ounces  of  the  powder  to  each 
1,000  cubic  feet  of  space,  it  will  kill  some  and  stupefy  the  others, 
causing  them  to  fall  on  the  floor,  where  they  can  be  swept  and 
burned.  It  is  well  to  pull  down  all  window  shades  except  one;  the 
insects  will  then  congregate  on  or  near  this  excepted  window,  where 
they  can  be  more  easily  swept  up.  This  powder  is  liable  to  many 
adulterations.  A  bright  yellow  color  is  often  imparted  to  it  by 
chromate  of  lead,  a  poisonous  substance  generally  disguising  an 
article  of  inferior  quality.  Pyrethrum  is  not  a  disinfectant,  but 
simply  an  insecticide  of  variable  efficiency.  As  its  fumes  are  harm- 
less to  man,  as  well  as  to  contents  of  houses,  it  affords  a  convenient, 
every-day  means  of  getting  rid  of  mosquitoes  in  spite  of  its  com- 
paratively high  cost.  In  rooms  suspected  of  harboring  mosquitoes 
infected  with  malarial  or  yellow  fever  germs,  more  effective  fumi- 
gants  must  be  employed. 

This  powder  is  also  largely  used,  as  such,  against  vermin,  freely 
sprinkled  wherever  needful. 

Datura  stramonium,  the  common  Jimson  weed,  powdered,  is  a 
good  insecticide  if  comparatively  fresh  and  mixed  with  one-fourth 

178 


INSECTICIDES  179 

of  saltpeter  to  make  it  burn  brightly.  But  it  is  of  variable  strength 
and  does  not  keep  well. 

Minim's  culicide  (Campho-phenol). —  Made  of  equal  parts,  by 
weight,  of  carbolic  acid  crystals  and  gum  camphor.  The  crystals 
are  melted  over  a  gentle  heat  and  the  solution  poured  slowly  over 
the  camphor,  the  result  being  a  clear,  somewhat  volatile  liquid  of 
rather  agreeable  odor.  It  is  permanent  and  may  be  kept  in  tight 
jars.  It  is  inflammable,  burning  with  an  intensely  smoky  flame, 
but  not  explosive.  It  volatilizes  rapidly  if  placed  over  an  ordinary 
alcohol  lamp.  As  it  may  take  fire  spontaneously  if  overheated,  it 
should  be  kept  at  a  certain  distance  from  the  flame,  and  not  more 
than  8  ounces  put  in  any  one  pan.  In  the  proportion  of  4  ounces 
per  1,000  cubic  feet  of  air,  volatilized  in  a  closed  room  (with  all 
large  cracks  pasted  up)  for  two  hours,  it  kills  all  the  mosquitoes  and 
temporarily  stupefies  the  flies  and  other  insects.  For  its  use  a 
simple  apparatus  can  be  readily  improvised  with  a  section  of  stove 
pipe,  8  inches  long,  cut  below  so  as  to  rest  on  3  legs,  and  with  a 
row  of  quarter-inch  holes  punched  around  near  the  top  for  the 
outlet  of  draft  (Fig.  32)  ;  an  alcohol  lamp  is  placed  beneath  and 
the  shallow  evaporating  basin  on  top.  Eight  ounces  of  the  liquid 
will  require  two  ounces  of  alcohol  for  its  volatilization.  Properly 
used,  this  preparation  ranks  next  to  sulphur  as  an  insecticide  in 
practical  fumigation,  but  costs  nearly  twice  as  much.  Unlike  sul- 
phur, it  does  not  affect  metals  nor  delicate  fabrics. 

Pyrofume.  —  A  clear,  straw-colored  liquid  derived  from  pine 
wood  by  fractional  distillation.  In  a  Public  Health  report  (1906), 
it  is  said  to  be  as  efficient  as  sulphur,  as  an  insecticide,  acting  more 
quickly  and  without  its  disadvantages.  For  its  proper  application 
a  special  device  is  necessary. 

Sulphur  dioxld. —  Proba'bly  the  best  of  known  insecticides. 
Being  equally  efficacious  in  dry  or  moist  air  no  moisture  need  be 
artificially  produced,  as  the  drier  the  air  the  less  the  injury  to  fur- 
nishings, colors,  etc.  With  all  cracks  and  crevices  closed,  the  burn- 
ing of  one  pound  of  sulphur  per  1,000  cubic  feet  of  space  will  kill 
flies  and  mosquitoes  within  two  hours  with  very  little  damage  to 
the  furniture.  Two  pounds  will  kill  rats  within  four  hours,  and 
five  pounds  will  destroy  most  bedbugs,  roaches,  lice,  within  six 
hours,  although  some  of  these  insects  usually  escape  by  running 
into  crevices.  (Public  Health  Bull.  No.  42.)  The  pot  method  de- 


i  So 


MILITARY    HYGIENE. 


scribed  on  page  727  may  be  used,  but  without  water.  Giles  recom- 
mends a  mixture  of  one  pound  each  of  niter  and  charcoal  to  eight 
of  sulphur,  which  burns  much  more  briskly  and  completely  than 
pure  sulphur. 


FIG.  32. —  A  simple  apparatus  for  fumigation,  from  piece  of  stove  pipe. 

Hydrocyanic  acid  gas.  —  This  gas  is  deadly  to  all  forms  of  animal 
life;  it  kills  surely  and  promptly  not  only  insects  and  vermin  of  all 
kinds,  but  also  rats  and  mice.  But  it  is  a  dangerous  agent  in  the 
hands  of  the  inexperienced  and  should  seldom  be  used  in  dwellings. 
In  careful  hands,  however,  it  is  very  useful  for  destroying  rodents 
and  all  forms  of  vermin  in  granaries,  barns,  stables,  etc.  The  pro- 
portions for  each  1,000  cubic  feet  of  space  are:  potassium  cyanid 
I  pound,  sulphuric  acid  1.5  pint,  water  2.25  pints.  The  acid  and 
water  are  first  mixed  in  an  earthen  vessel  and,  when  the  mixture 
has  cooled  down,  the  cyanid  (previously  placed  in  a  gauze  bag) 
dropped  into  it.  On  account  of  the  rapid  evolution  of  the  gas  the 


INSECTICIDES.  l8l 

operator  must  quickly  leave  the  room.  The  time  of  exposure  is 
only  two  or  three  hours,  and  no  one  should  enter  the  building  until  it 
has  been  aired  8  to  10  hours  (Pub.  Health  Bull.  No.  42). 

Formaldehyde  is  a  feeble  insecticide  and  not  to  be  relied  upon  for 
the  destruction  of  mosquitoes  and  flies  unless  a  very  large  volume 
of  gas  is  liberated  quickly  so  that  it  may  diffuse  to  all  portions  of 
the  space  in  sufficient  concentration.  When  thus  generated,  as  in 
Munson's  method,  it  has  been  proved  to  be  a  -convenient  and  effective 
insecticide  (see  page  732). 

Mercuric  chloride  (corrosive  sublimate)  evaporated  in  a  porcelain 
dish  over  an  alcohol  lamp,  in  the  proportion  of  one  ounce  per  1,000 
cubic  feet  of  space  is,  according  to  Surgeon  G.  M.  Guiteras,  P.  H.  S., 
as  effective  as  sulphur  against  flies  and  mosquitoes,  and  much 
cheaper.  If  metal  surfaces  are  wiped  off  immediately  after  fumi- 
gation they  are  not  tarnished,  nor  are  fabrics  injured. 

Of  liquid  insecticides  may  be  mentioned  lime  bisulphide,  carbon 
bisulphide,  gasoline  and  benzine.  Lime  bisulphide  is  prepared  by 
boiling  together  for  an  hour  or  two,  in  water,  equal  parts  of  flowers 
of  sulphur  and  quicklime,  and  diluting  with  more  water.  It  is 
used  by  pouring  into  the  cracks  and  crevices  supposed  to  harbor 
vermin.  Gasoline  and  benzine  are  used  in  the  same  manner.  Carbon 
bisulphide  evaporates  rapidly  at  ordinary  temperature,  and  one 
pound  to  1,000  cubic  feet  of  air-space  (in  sealed  room)  will  gen- 
erate enough  fumes  to  destroy  all  insects,  including  roaches.  All 
these  liquids,  except  lime  bisulphide,  are  highly  inflammable  and 
must  be  used  with  the  utmost  caution  against  fire. 


CHAPTER    XVI. 
RECRUITING.* 

Next  to  hygiene,  the  most  important  factor  in  securing  the 
physical  efficiency  of  the  soldier  is  the  proper  selection  of  the  recruit. 
None  but  able-bodied  men  must  be  enlisted  or  mustered  in.  They 
alone  can  stand  the  exposure  and  hardships  to  which  troops  are 
exposed  and  acquire  the  endurance  to  fatigue  and  resistance  to  dis- 
ease which  make  up  the  reliable  and  effective  soldier.  Delicate,  un- 
developed and  immature  young  men  and  those  who  suffer  from 
chronic  ailments  are  easily  exhausted  by  hard  work,  privations  and 
the  inclemencies  of  the  weather,  and  an  easy  prey  to  infectious 
diseases,  weakening  the  ranks  they  are  intended  to  strengthen  and 
falling  by  the  wayside  when  most  needed,  so  that  they  crowd  the 
ambulances  and  hospitals  especially  needed  for  the  wounded,  and 
later  become  pensioners  of  the  Government  which  they  never  have 
usefully  served.  The  best  hygienic  conditions  will  never  make 
hardy  men  or  good  soldiers  of  them.  Not  only  are  they  ineffective 
but,  still  worse,  they  often  require  the  care  of  able-bodied  men  thus 
withdrawn  from  the  effective  forces. 

There  is  therefore  no  more  important  duty  devolving  upon  the 
medical  officer  than  the  examination  of  applicants  for  enlistment, 
none  that  is  productive  of  better  and  more  important  results.  This 
is  shown,  in  our  past  wars,  by  the  difference  between  the  morbidity 
and  mortality  of  regulars  and  those  of  volunteers,  the  medical  offi- 
cers of  volunteer  troops  having  examined  their  applicants  without 
the  necessary  strictness  or,  rather,  having  been  compelled  by  the 
exigencies  of  the  situation  to  accept,  against  their  better  judgment, 
men  below  the  required  standards.  Thus,  in  the  Civil  War,  the 
annual  mortality  from  disease  and  discharges  for  disability  were 
respectively  55  and  91  per  1,000  for  volunteers  and  only  32  and  68 
for  regulars.  In  the  year  1900,  the  admissions  for  disease  per  1,000 
of  strength  were  1,821  for  regulars  and  2,762  for  volunteers,  while 
the  mortality  was  12  and  25  respectively. 

This  matter  of  examining  applicants  for  enlistment  is  deemed  so 

*  See  Triplet's  Manual  on  the  Examination  of  Recruits,  by  Chas.  R.  Green- 
leaf,  Col.,  Asst.  Surg.  Gen.,  U.  S.  A. 

182 


RECRUITING.  183 

important  that,  under  existing  United  States  Army  Regulations, 
medical  officers  are  required  to  perform  the  duties  of  recruiting  offi- 
cers at  recruit  depots  and  other  large  posts  where  they  are  available 
for  the  purpose,  and  are  alone  responsible  for  the  acceptance  or 
rejection  of  applicants. 

As  a  general  rule,  the  higher  the  social  class  to  which  the  recruit 
belongs,  the  better  he  will  be  physically  as  well  as  mentally,  for  it 
is  notorious  that  in  European  armies,  where  military  service  is 
obligatory,  the  officers  are  usually  taller  and  heavier  than  the 
enlisted  men.  Vision  is  an  exception  to  this  rule,  for  it  grows  more 
imperfect  as  we  ascend  the  social  scale,  so  that  perfect  eyesight  is 
oftener  found  in  the  middle  and  lower  than  in  the  higher  and  better 
educated  classes.  The  physical  and  mental  aptitudes  of  recruits 
are,  to  a  great  extent,  the  resultant  of  their  previous  environment, 
occupation  and  education ;  these  factors  therefore  must  be  duly  con- 
sidered. Youths  from  the  country  are  stronger,  heavier,  healthier 
and  more  enduring  than  city-bred  boys,  generally  also  of  better 
habits  and  character,  but,  on  the  other  hand,  they  are  hard  to  break 
in,  slow  to  accommodate  themselves  to  their  new  conditions  and  to 
acquire  the  smart  step  and  martial  bearing  of  the  trained  soldier. 
The  city  recruit  is  more  supple  and  adaptable,  and  sooner  trained 
for  an  emergency ;  he  is  also  more  likely  to  be  immune  to  infectious 
diseases  and  to  have  had  some  training  in  mechanical  trades,  the 
latter  being  valuable  accomplishments  in  modern  war;  but  he  is 
lacking  in  vigor,  endurance  and  stability  of  character. 

AGE.  —  "Applicants  for  first  enlistment  must  be  between  the 
ages  of  18  and  35  years,  of  good  character  and  temperate  habits, 
able-bodied,  free  from  disease,  and  must  be  able  to  speak,  read  and 
write  the  English  language. 

"  No  person  under  18  years  of  age  will  be  enlisted,  reenlisted,  or 
accepted  with  a  view  to  enlistment,  and  minors  between  the  ages  of 
1 8  and  21  years  must  not  be  enlisted,  or  accepted  with  a  view  to 
enlistment,  without  the  written, consent  of  the  father,  only  surviving 
parent,  or  legally  appointed  guardian,  to  the  minor's  enlistment. 

"  Original  enlistments  will  be  confined  to  persons  who  are  citizens 
of  the  United  States  or  of  Porto  Rico,  or  who  have  made  legal  decla- 
ration of  their  intention  to  become  citizens  of  the  United  States." 

It  is  a  well-known  fact  that  the  human  body  grows  and  develops 
until  at  least  the  age  of  25.  Before  this  the  bones  are  not  fully 


184  MILITARY    HYGIENE. 

formed;  the  epiphyses  are  not  all  ossified  and  united;  the  sacrum 
and  sternum  are  not  yet  consolidated ;  nor  has  the  body  reached  its 
full  height,  weight  and  chest  capacity.  We  enjoy  our  best  physical 
development  and  greatest  strength  from  25  to  30,  the  lungs  not  gain- 
ing their  maximum  capacity  until  30  or  35.  Therefore,  in  theory, 
the  older  the  recruit,  if  under  30,  the  better  he  is  physically  and 
mentally.  But,  in  practice,  there  are  other  aspects  of  the  question 
to  be  considered.  After  25,  most  of  the  desirable  young  men  have 
cfiosen  their  trade  or  profession,  therefore  are  more  or  less  settled 
in  life  and  no  longer  think  of  enlistnig.  Furthermore,  at  that  age 
their  habits  are  formed  and  they  could  not  so  easily  be  broken  into 
the  new  and  very  different  ways  of  military  life.  Were  it  possible 
to  secure  enough  recruits  22  years  old,  it  would  be  in  the  interest 
of  the  service  to  do  so ;  but  as  this  is  generally  impossible,  the  mini- 
mum age  must  remain  at  21. 

In  European  countries,  where  the  military  service  is  obligatory 
for  all,  the  age  is  20  (21  in  Russia),  although  many  of  the. young 
conscripts  do  not  really  get  under  the  colors  until  they  are  21.  There 
the  age  has  to  be  that  which  follows  the  period  of  education  and 
precedes  that  of  the  selection  of  a  profession  or  trade. 

Experience  has  shown  that,  under  20,  soldiers  are  incapable  to 
stand  the  fatigue  and  hardships  of  a  campaign,  and  military  his- 
tory contains  many  complaints  of  commanders  whose  hospitals  were 
full  of  young,  immature  soldiers.  It  is  stated  that  the  French  Army 
which  won  the  glorious  battle  of  Austerlitz,  in  1805,  after  a  forced 
march  of  more  than  1,000  miles,  leaving  but  few  sick  en  route,  con- 
tained no  men  below  the  age  of  22 ;  while  the  army  which  won  the 
bloody  and  indecisive  battle  of  Wagram,  in  1809,  after  scattering 
many  sick  and  wounded  on  the  way,  was  mainly  composed  of  much 
younger  soldiers. 

In  our  service,  more  men  enlist  in  their  twenty-first  year  than  at 
any  other  age. 

In  the  British  Army  the  age  of  enlistment  is  between  18  and  25, 
more  than  half  of  the  recruits  .being  under  20  years,  an  age, 
according  to  Melville,  "  of  greater  moral  and  physical  receptivity." 
Such  age  would  certainly  be  dangerously  low,  were  it  not  that  the 
enlistment  is  for  12  years,  7  with  the  colors  and  5  in  the  reserve, 
so  that,  in  reality,  the  Army  is  composed  of  a  majority  of  well- 
trained  soldiers  from  21  to  25.  A  convincing  proof  that  this  sys- 


RECRUITING.  185 

tem  is  not  detrimental  to  health  is  that,  notwithstanding  the  world- 
wide colonies  of  the  empire,  the  mortality  of  the  British  Army  is 
less  than  that  of  the  U.  S.  Army. 

In  France  and  Germany,  where  the  term  of  military  service  is 
only  three  and  two  years,  respectively,  the  proportion  of  men  under 
21  years  and  imperfectly  trained  is  necessarily  much  greater  than  in 
the  English  Army.* 

At  what  age  ceases  the  aptitude  for  military  service?  It  will 
seldom  be  in  the  interest  of  the  service  to  enlist  men  over  30  years 
old,  and  the  legal  limit  of  35  is  only  intended  to  be  used  in  times  of 
emergency.  "  It  has  been  observed  that  for  acceptable  colored 
recruits  the  age  of  25  or  26  is  practically  the  maximum,  because  after 
that  they  are  liable  to  be  physically  stiffened  and  mentally  dulled  " 
(Greenleaf}.  There  is  no  age  limit  for  reenlistment  in  our  Army, 
but  it  is  recognized  that  the  soldier  grows  old  quickly  in  barracks 
and  in  the  field.  After  20  years  in  the  ranks,  when  past  40  years  of 
age,  he  soon  becomes  unequal  to  the  arduous  duties  of  field  service. 
The  Army  Regulations  provide  that  when  an  enlisted  man  shall  have 
served  as  such  for  30  years  he  may  apply  for  retirement ;  but 

*  NOTE. —  All  that  is  stated  in  this  chapter,  as  may  readily  be  seen,  was 
written  before  the  present  European  War  had  been  begun  or  expected. 

Physiological  facts  cannot  be  changed,  but  their  adaptation  to  new  war 
conditions  now  demands  consideration.  This  is  a  war  between  armed 
nations,  in  which  all  available  resources  in  men  and  supplies  must  be  util- 
ized. The  problem  is  no  longer  how  to  mobilize  a  certain  number  of  able- 
bodied  men,  but  how  to  obtain  the  greatest  output  from  universal  service. 
In  Europe,  all  men  under  45,  not  clearly  disqualified,  are  already  under  arms. 
Men  of  50  may  soon  be  called,  where  they  are  not  already  mobilized. 

There  is  no  doubt  that  men  suffering  from  minor  disabilities,  or  who  are 
past  40  and  therefore  beyond  the  period  of  highest  physical  efficiency,  are 
still  capable  of  rendering  valuable  military  service,  provided  they  are  as- 
signed to  the  duty  for  which  they  are  fitted,  and  it  is  the  medical  officer  who 
should  determine  the  nature  of  this  duty. 

Notwithstanding  our  deep-rooted  hostility  to  conscription,  the  irresistible 
logic  of  events  has  compelled  Congress  to  enact  the  Universal  Training  and 
Service  law,  calling  to  the  colors  all  able-bodied  men  from  21  to  31.  The 
principle  that,  in  the  event  of  war,  it  is  the  duty  of  all  citizens  to  take  up 
arms  in  defense  of  their  country  being  thus  established,  we  may  assume  that 
our  wars,  hereafter,  will  be  fought  not  by  costly  and  inefficient  volunteers 
but  by  drafted  and  well-trained  citizens. 

In  order  to  mobolize  large  numbers  of  men  in  as  short  a  period  of  time 
as  possible,  it  may  become  necessary  to  relax  the  strictness  of  some  of  the 
requirements  of  our  physical  examination,  at  least  for  some  of  the  branches 
of  the  service.  In  such  case,  we  need  hardly  say,  the  physical  defects  of  the 
recruit  should  be  carefully  recorded  in  order  to  guard  the  national  treasury 
against  subsequent  claims  which,  with  our  loose  and  extravagant  pension 
system,  might  become  an  intolerable  burden  upon  the  country. 


l86  MILITARY    HYGIENE. 

there  are  few  enlisted  men  who  serve  usefully  and  efficiently  until 
the  age  of  51.  The  so-called  veterans  of  Napoleon  were  men  of 
26  to  28  years,  and  his  "  old  guard  "  consisted  of  men  from  28  to 
29;  at  Austerlitz  the  oldest  soldiers  were  33,  and  at  Friedland  36 
years  old  (Rouget  et  Dopier}. 

Youths  under  21  often  present  the  appearance  of  the  physical' 
signs  of  maturity  and  may  attempt  to  deceive  the  recruiting  officer. 
The  latter  therefore  should  be  very  particular  to  ascertain  the  cor- 
rect age  of  applicants,  the  more  so  that  a  minor  who  enlists  by  deceit 
may,  upon  application  of  his  parent  or  guardian,  be  discharged  from 
the  Army,  thus  causing  the  loss  to  the  Government  not  only  of  his 
service  but  of  his  pay  and  equipment.  According  to  Greenleaf, 
there  are  certain  evidences  of  maturity  which  usually  accompany 
the  period  of  legal  majority  and  with  which  the  recruiting  officer 
should  familiarize  himself. 

"At  twenty-one  years  of  age  the  wisdom  teeth  are  usually  cut, 
and  on  each  side  of  both  jaws  there  should  be  found  five  grinders, 
viz.,  three  large  double  or  molar  teeth  and  two  smaller  double  or 
biscuspid  teeth.  In  case  of  the  loss  of  teeth  the  spaces  originally 
occupied  by  them  may  be  seen. 

"  Under  twenty-one  years  of  age  the  wisdom  teeth  are  seldom  to 
be  found,  and  there  will,  therefore,  be  but  four  grinders  on  each 
side  of  both  jaws,  viz.,  two  molars  and  two  bicuspids. 

"At  maturity  there  should  be  some  beard  upon  the  face,  and 
hair  under  the  arms,  a  full  growth  around  and  above  the  genital 
organs,  and  some  scattered  hairs  in  the  neighborhood  of  the  anus. 
The  hair  of  the  body  is  generally  fine  and  silky. 

"After  maturity,  the  hair  is  thick  and  coarse  in  the  various  places 
mentioned. 

"After  maturity  the  skin  of  the  scrotum  is  somewhat  darker  in 
color  than  the  surrounding  parts,  is  opaque,  and  is  marked  in  various 
directions  by  wrinkles  or  folds; 

"  Before  maturity  this  skin  retains  the  soft,  velvety  condition  of 
youth,  its  pink  or  fresh  flesh  color,  and  is  more  or  less  translucent, 
while  the  wrinkles  or  folds  are  not  well  pronounced,  or  are  entirely 
absent,  particularly  at  the  sides.  This  condition  of  the  scrotum  is 
the  most  valuable  of  the  signs  of  maturity." 

In  hot  countries,  where  man  has  to  contend  against  depressing 
climatic  conditions  and  endemic  infectious  diseases,  very  young  sol- 


RECRUITING.  187 

diers  are  particularly  exposed  to  grave  dangers  and  soon  become 
non-effective.  Only  matured,  well-trained  men,  of  at  least  22,  should 
be  sent  to  the  tropics  for  active  duty. 

HEIGHT,    WEIGHT    AND    CHEST    MEASUREMENT. 

To  determine  the  physical  condition  of  applicants  for  enlistment 
it  is  necessary  to  ascertain  whether  the  height,  weight  and  chest 
measurements  come  up  to  established  standards  and  bear  certain 
definite  proportions  to  one  another. 

Height.  —  Our  Army  is  recruited  not  only  from  native  Ameri- 
cans, but  also  from  the  naturalized  emigrants  of  many  countries, 
differing  more  or  less  in  physical  characteristics.  According  to 
Kilbourne,  the  North  American  Indians  are  taller  than  any  other 
race  on  this  continent,  the  adult  males  averaging  5  feet  7.93  inches. 
Next  in  size  are  the  native  white  Americans,  whose  average  height, 
in  the  Civil  War,  was  5  feet  7.67  inches.  Among  our  naturalized 
citizens,  the  Norwegians,  Scotch  Canadians,  Swedes  and  Irish  come 
next,  in  the  order  named.  The  American  negro  follows,  with  an 
average  of  5  feet  6.62  inches.  Lower  in  the  scale,  but  still  about  5 
feet  5  inches,  are  the  English,  Hungarians,  Germans,  Swiss,  French 
and  Poles.  The  Italians  and  Austrians  are  5  feet  5  inches  or  under. 

In  this  country,  "  the  average  stature  of  a  youth  of  18  years  of 
age,  a  '  growing  lad/  is  a  little  over  5  feet  4  inches,  and  this  increases 
gradually  until  he  reaches  the  age  of  25  years  —  about  the  stage  of 
physical  maturity  or  manhood  —  when  his  average  height  is  between 
5  feet  7  inches  and  5  feet  8  inches  "  (Greenleaf). 

For  the  years  1910  and  1911,  in  our  Army,  the  average  height 
of  white  recruits  was  5  feet  7.56  inches.  Of  white  recruits  49  per 
cent.,  and  of  colored  recruits  47  per  cent.,  were  5  feet  8  inches  or 
over.  In  the  British  Army,  the  average  height  of  recruits  for  1909 
was  5  feet  6l/2  inches. 

Our  Army  Regulations  provide  that:  For  infantry,  coast  artil- 
lery and  engineers  the  height  must  not  be  less  than  5  feet  4  inches ; 
for  cavalry  and  field  artillery  (except  mountain  batteries)  not  less 
than  5  feet  4  inches  and  not  more  than  5  feet  10  inches ;  for  moun- 
tain batteries,  not  less  than  5  feet  8  inches  and  not  more  than  6  feet. 
A  variation  not  exceeding  a  fraction  of  an  inch  above  the  maximum 
height  given  for  cavalry  and  artillery,  is  permissible  if  the  appli- 
cant is  in  good  health  and  in  other  respects  desirable  as  a  recruit. 


1 88  MILITARY    HYGIENE. 

In  foreign,  countries,  the  minimum  height  is  64  inches  for  the 
English,  62  for  the  Germans  and  less  than  62  for  other  armies.  In 
the  French  Army,  the  minimum  limit,  reduced  to  60.5  inches  in  1872, 
was  entirely  discarded  in  1901,  on  the  ground  (for  us  inadmissible) 
that  physical  aptitude  is  independent  of  height. 

It  must  be  admitted,  however,  that  height  has  not  the  value  of 
former  days  when  a  certain  spectacular  effect  was  expected  from 
the  uniformed  soldier,  and  that  relatively  small  men  are  quicker, 
more  active,  enduring  and  resistant  than  tall  men;  thus  the  French 
troops  which  are  the  best  marchers  in  Europe  average  at  least  two 
inches  less  than  the  English  and  American  troops.  There  is  no 
doubt  that,  in  our  service,  the  minimum  height  for  enlisted  men 
could  be  safely  lowered  to  63  inches  without  loss  of  efficiency. 

In  a  full-grown  and  well-proportioned  subject,  his  strength  and 
staying  power  increase  with  his  height,  but  a  maximum  limit  is  soon 
reached  beyond  which  it  is  not  advisable  to  go.  Tall  men,  that  is, 
men  exceeding  6  feet,  are  objectionable,  for  in  them,  as  a  rule,  the 
lungs  and  heart  are  not  developed  nor  their  muscular  energy 
increased  in  proportion  to  their  height,  so  that  they  are  less  able  to 
stand  hard  marching  and  endure  hardships  than  much  smaller  men. 
Furthermore,  tall  men  require  more  food,  more  clothing,  and  —  not 
a  negligible  consideration  —  offer  a  larger  target  to  the  enemy. 

For  admission  to  the  United  States  Military  Academy,  candidates 
17  years  old  must  be  at  least  64  inches  tall,  and  those  18  years  and 
upward  at  least  65  inches. 

Weight.  —  In  our  Army  the  minimum  weight  for  all  arms  of  the 
service  is  128  pounds,  subject  to  slight  variations  as  explained  on 
page  192 ;  but  in  no  case  will  an  applicant  whose  weight  falls  below 
1 20  pounds  be  accepted  without  special  authority  from  the  Adjutant 
General  of  the  Army.  The  maximum  must  not  exceed  190  pounds 
for  infantry,  coast  artillery  and  engineers,  nor  165  pounds  for  cav- 
alry and  field  artillery. 

Weight  is  of  the  greatest  importance  in  the  examination  of 
recruits,  giving,  in  connection  with  the  height,  a  valuable  indication 
of  the  development  of  organs  as  well  as  of  the  firmness  and  com- 
pactness of  tissues,  but  it  is  necessary  to  see  that  the  weight  is 
chiefly  that  of  the  organs  and  tissues  most  concerned  in  the  pro- 
duction of  physical  strength,  namely,  bones  and  muscles,  and  that 
there  is  no  excess  of  fat  or  protuberance  of  abdomen. 


RECRUITING.  189 

In  our  service,  the  proportion  which  should  exist  between  height 
and  weight  is  formulated  by  Greenleaf  as  follows: 

"  For  each  inch  of  height  from  5  feet  4  inches  to  5  feet  7  inches, 
inclusive,  there  should  be  calculated  2  pounds  of  weight.  When 
the  height  exceeds  5  feet  7  inches,  calculate  2  pounds  of  weight  for 
the  whole  number  of  inches  of  height ;  add  to  this  product  5  pounds 
of  weight  for  each  inch  of  difference  between  5  feet  7  inches  and 
the  actual  height ;  the  sum  will  be  the  normal  weight  in  pounds." 

For  the  years  1910  and  1911,  in  the  U.  S.  Army,  the  average 
weight  of  white  recruits  was  145  pounds.  Of  white  recruits  58.07 
per  cent.,  and  of  colored  recruits  73.6  per  cent,  weighed  140  pounds 
or  over. 

In  Europe,  the  minimum  weight  admissible  ranges  from  no  to 
1 20  pounds.  The  weight  requirement,  in  proportion  to  size,  is  also 
somewhat  less  than  with  us;  thus  in  France  and  Belgium,  the 
recruit  is  accepted  if  his  weight  is  7  or  8  kilos  below  the  number 
represented  by  the  decimals  of  his  height  expressed  in  the  metric 
system;  for  instance,  a  man  i  meter  63  centimeters  high  (64  inches) 
need  not  weigh  more  than  63  —  7=56  kilos,  or  123  pounds. 

In  the  British  Army,  for  1909,  the  average  weight  of  recruits  was 
130.1  pounds,  the  minimum  required  being  120. 

Chest  Measurement.  —  The  chest  contains  the  heart  and  lungs, 
the  most  important  organs  of  the  body ;  therefore  its  development 
is  of  particular  significance  as  indicating  the  vital  power  and 
endurance  of  the  recruit.  As  the  body  increases  in  size  and  weight, 
a  proportional  increase  of  the  chest  must  take  place  in  order  to  fur- 
nish the  greater  amount  of  nervous  and  muscular  energy  required. 
A  short,  narrow  or  thin  chest  is  never  desirable  in  an  applicant  for 
enlistment,  particularly  if  long-legged. 

A  still  more  useful  indication  than  the  mere  size  of  the  thorax  is 
the  respiratory  capacity  of  the  lungs.  This  capacity  is  best  deter- 
mined by  the  spirometer  which  shows  the  actual  amount  of  expired 
air  after  a  forced  inspiration.  But  the  use  of  this  apparatus  has 
not  yet  become  generalized  and  the  respiratory  capacity  is  usually 
determined  by  measuring  the  chest  mobility. 

This  measurement  of  the  chest  mobility,  however,  is  open  to 
objections.  It  makes  no  allowance  for  diaphragmatic  breathing,  or 
the  fact  that  narrowness  of  chest  may  be  compensated  by  length ; 
nor  does  it  take  account  of  abnormal  contraction  of  muscles  and 


MILITARY    HYGIENE. 

obesity  of  chest  walls.  Errors  are  also  frequent  in  the  handling 
of  the  tape  so  that  different  examiners  of  the  same  subject  seldom 
obtain  the  same  figures.  From  careful  experiments,  Owen  (Mil. 
Surg.,  May,  1900)  concludes  that  mistakes  with  the  tape  are  much 
more  liable  to  occur  than  with  the  spirometer;  that  the  use  of  the 
latter  gives  more  accurate  and  valuable  information,  aiding  in 
excluding  men  in  the  pre-tubercular  stage,  men  perhaps  with  large 
muscular  development  but  small  pulmonary  capacity.  The  two  sys- 
tems could  be  usefully  combined,  applying  the  tape  to  robust  and 
normally  developed  men,  and  reserving  the  spirometer  for  thin- 
chested  or  very  stout  men. 

According  to  the  regulations  governing  recruiting  in  our  Army, 
"  The  chest  mobility,  i.  e.,  the  difference  between  the  measurement 
at  inspiration  and  expiration,  should  be  at  least  2  inches'  in  men 
below  5  feet  7  inches  in  height,  and  2^  inches  in  those  above  that 
height."  A  large  proportion  of  men  have  a  chest  expansion  of  3 
to  4  inches. 

It  may  be  formulated,  in  a  general  way,  that  the  measurement  at 
expiration  should  be  at  least  equal  to  one-half  of  the  height ;  thus  a 
man  66  inches  high  should  not  measure  less  than  33  inches.  In  our 
service,  the  rule  is  that  a  man  whose  chest  measures  less  than  32 
inches  at  expiration,  whatever  his  height  may  be,  should  be  rejected, 
unless  otherwise  specially  desirable. 

For  the  years  1910  and  1911,  in  the  Army,  48.31  per  cent,  of  white 
recruits,  and  52.41  of  colored  recruits  had  a  chest  measurement  of 
34  inches  and  over  at  expiration. 

Antony  found  that  in  French  soldiers  affected  with  respiratory 
diseases,  especially  tuberculosis,  43  per  cent,  present  a  chest  perim- 
eter smaller  than  half  the  height. 

"  The  circumference  of  the  chest  is  measured  by  passing  the  tape 
around  it  immediately  at  the  point  of  the  shoulder  blade,  the  arms 
hanging  down.  Generally  the  tape  will  then  be  found  to  fall  below 
the  nipple. 

"  In  taking  this  measure  contortions  of  the  body,  such  as  bend- 
ing backward  to  '  throw  out '  the  chest  or  bending  forward  to 
'  draw  it  in,'  should  be  avoided. 

"  The  applicant  should  stand  erect  without  muscular  strain  or 
rigidity.  After  the  tape  is  placed  in  position  and  lies  snugly  and 
evenly  upon  the  skin,  and  while  the  loose  ends  are  held  between 


RECRUITING. 


the  fingers  of  the  examiner  so  that  when  the  chest  is  expanded  the 
tape  will  run  readily  through  them,  the  applicant  should  be  directed 
to  draw  in  slowly  and  steadily  a  long  breath  until  his  chest  is  inflated 
to  its  utmost  capacity,  when  the  record  of  chest  circumference  at 
inspiration  should  be  read  from  the  tape.  He  is  then  to  expel  the 
air  by  counting1  slowly  and  steadily  from  one  onward  until  he  can 
no  longer  resist  the  urgent  demand  for  inspiration,  when  the  record 
of  chest  circumference  at  expiration  should  be  read.  This  should 
be  repeated  several  times  to  insure  accuracy.  Many  men  are  ex- 
tremely awkward  in  developing  their  chest  capacity  on  demand  and 
great  care  and  patience  are  necessary  in  getting  the  true  measure- 
ments "  (Greenleaf). 

The  French  regulations  prescribe  to  place  the  tape  along  the  lower 
pectoral  line,  which  is  2  or  3  centimeters  below  the  nipple. 

Pignet's  "  index  "  to  estimate  the  physical  condition  and  efficiency 
of  recruits,  and  now  much  used  in  Europe,  is  obtained  by  adding 
the  chest  measurement  (in  centimeters)  at  expiration,  to  the  weight 
(in  kilos),  and  then  subtracting  the  sum  from  the  height  (in  centi- 
meters) ;  thus:  index  =  H — (W-f-C).  The  smaller  the  index 
the  stronger  the  man,  and  any  recruit  may  be  accepted  whose  index 
does  not  exceed  20  or  25.  This  method  rests  on  correct  principles 
so  long  as  the  height  does  not  fall  below  the  accepted  standard. 

The  following  table  is  given  in  our  recruiting  regulations  for  con- 
venience of  reference : 

Table  of  physical  proportions  for  height,  weight,  and  chest 
measurement. 


Chest  measurement 

Height 

Weight 

At  expiration 

Mobility 

Incites 
64 

Pounds 
128 

Inches 
32 

Inches 

2 

65 

130 

32 

2 

66 

132 

32* 

2 

67 

134 

33 

2 

68 

141 

33i 

2* 

69 

148 

33* 

2* 

70 

155 

34 

2* 

7i 

162 

34* 

2i 

72 

169 

34f 

3 

73 

176 

35* 

3 

192 


MILITARY    HYGIENE. 


It  is  not  necessary  that  the  applicant  should  conform  exactly  to 
the  figures  indicated  in  the  foregoing  table.  The  following  varia- 
tions below  the  standard  given  in  the  table  are  permissible  when  the 
applicant  for  enlistment  is  active,  has  firm  muscles,  and  is  evidently 
vigorous  and  healthy: 


Height 

Chest  at  expiration 

Weight 

Inches 
64  and  under  68  

Inches 

2 

Pounds 
8 

68  and  under  69  

2 

12 

69  and  under  "70  

2 

1C 

70  and  upward  

2 

2O 

In  1897,  there  were  6,062  native  whites  accepted  for  the  United 
States  Army.  Of  these,  3,243  ranged  in  age  from  21  to  24;  they 
averaged  in  height  67.79  inches,  and  in  chest  measurement  33.92 
inches  at  expiration  and  36.99  inches  at  inspiration.  The  remaining 
2,819  ranged  in  age  from  25  to  39,  with  practically  the  same  average 
height  but  about  a  half-inch  increase  of  chest  measurement,  at  both 
expiration  and  inspiration,  the  expansion  being  the  same,  almost 
exactly  3  inches. 

During  the  Civil  War,  Baxter  found  that  the  native-born  whites 
had  an  average  expansion  of  2.80  inches. 

Causes  of  Rejection  and  Discharge.  —  For  trie  years  1910  and 
1911,  in  the  U.  S.  Army,  the  principal  causes  of  rejection,  by  recruit- 
ing and  examining  officers,  in  order  of  frequency,  were  venereal 
diseases,  heart  diseases,  affections  of  the  eye  and  defects  of  vision, 
affections  of  the  ear  and  deafness,  flat  feet,  malformation  or  defects 
of  development,  alcoholism. 

The  principal  causes  of  discharge  during  the  same  years,  in  order 
of  frequency,  were  tuberculosis,  venereal  diseases,  insanity,  heart 
diseases,  flat  feet,  congenital  malformation  or  defects  of  develop- 
ment, epilepsy.  It  thus  appears  that,  with  the  possible  exception  of 
venereal  diseases,  all  the  other  conditions  mentioned  probably  ex- 
isted previous  to  enlistment  and  that  many  could  have  been  detected 
by  a  stricter  scrutiny  on  the  part  of  the  examining  officers. 


RECRUITING.  193 

MODE    OF    EXAMINING    AN    APPLICANT    FOE,    ENLISTMENT. 

This  examination  is  physical,  mental  and  moral. 

Physical.  —  The  recruit  is  to  be  examined  stripped,  in  a  large, 
well-lighted  room,  after  he  has  taken  a  bath.  The  examining  officer 
proceeds  in  the  following  order : 

1.  General  physique,  skin,  scalp  and  cranium,  ears,  eyes,  nose, 
mouth,  face,  neck  and  chest ;  chest  measurements. 

2.  The  arms   being   extended  above  the   head,   backs   of  hands 
together,  the  applicant  is  required  to  cough  vigorously ;  any  form  of 
rupture  may  now  be  discovered  by  the  hand  and  eye,  but  still  better 
by  the  index  finger  passed  up  to  the  external  ring. 

3.  The   arms   remaining  extended   above   the  head,  the  man   is 
required  to  take  a  long  step  forward  with  the  right  foot  and  bend 
the  right  knee ;  the  genital  organs  are  now  conveniently  exposed  and 
varicocele  and  other  defects  in  the  scrotum  may  be  recognized. 

4.  Arms  down  and  the  man  required  to  separate  the  buttocks  with 
his  hands,  at  the  same  time  bending  forward ;  this  exposes  the  anus. 

5.  Heart  and  lungs;  rate  of  pulse  and  respiration. 

6.  Upper  extremities,  making  sure  that  all  joints  are  free  and 
supple,  from  the  phalanges  to  the  shoulder. 

7.  Lower  extremities;  the  applicant  is  required  to  leap  directly 
up,  striking  the  buttocks  with  the  heels,  to  hop  the  length  of  the 
room  on  the  ball  of  first  one  foot  and  then  the  other,  to  make  a  stand- 
ing jump  as  far  as  possible  and  repeat  it  several  times,  to  run  the 
length  of  the  room  in  double-time  several  times;  after  which  his 
heart  and  lungs  are  reexamined. 

Mental  and  Moral.  —  No  standard  is  prescribed  for  the  mental 
examination,  but  the  man  should  be  able  to  read  and  write,  and  give 
evidence  of  primary  education  and  of  normal,  sound  understanding. 
The  advances  in  the  art  of  war  and  the  use  of  modern  weapons 
require  a  much  higher  degree  of  intelligence  on  the  part  of  recruits 
than  formerly,  and  no  future  war  can  be  waged  successfully  except 
by  soldiers  who  think  for  themselves  and  have  a  clear  conception  of 
their  duties. 

Mental  diseases  form  one  of  the  chief  causes  of  discharge  from 
the  Army.  During  the  5  years  1905-1910,  520  mental  cases  were 
reported,  or  about  1.40  per  thousand.  In  the  German  Army,  the 
ratio  was  i.io  in  1906.  There  is  no  doubt  that  most  of  these  cases 
exist  at  the  time  of  enlistment  and  could  be  eliminated  by  a  trained 


194  MILITARY    HYGIENE. 

psychiatrist.  The  most  frequent  mental  abnormalities  in  military 
life  are  weak-mindedness,  dementia  precox,  degenerative  psychoses 
and  hysteria.  About  50  per  cent,  of  the  cases  are  more  or  less 
complicated  with  alcoholism. 

In  view  of  the  many  and  serious  troubles  caused  by  defectives 
and  dements  in  military  organizations,  careful  attention  should  be 
given  to  the  mental  state  of  applicants  for  enlistment  by  medical 
officers  specially  instructed  in  psychiatry.  The  life  history  of 
applicants,  whenever  obtainable,  will  furnish  most  useful  information 
in  this  regard:  an  aimless  and  wandering  life,  frequent  changes  of 
occupation,  lack  of  primary  education,  confinement  in  reform  school, 
etc.,  are  all  suspicious  indications.  Much  of  the  mental  and  moral 
states  of  applicants  can  be  revealed  by  suitable  questions.  De- 
fectives, dements  and  degenerates  exhibit  defects  of  memory  and  an 
inability  to  do  connected  thinking;  they  have  little  power  of  atten- 
tion and  concentration,  and  tire  very  easily ;  or  else  give  evidence 
of  irritability,  boastfulness,  sometimes  of  brilliancy,  with  more  or 
less  excentricity  of  manner  or  speech.  Some  information  may  also 
be  obtained  from  the  so-called  stigmata  of  degeneration,,  such  as 
asymmetry  of  face  and  head,  low  and  narrow  retreating  forehead 
with  projecting  eyebrows,  deformed  nose  or  ear  lobes,  high-arched 
or  cleft  palate. 

The  moral  character  should  be  scrutinized  with  care  in  order  that 
enlistments  from  the  vagrant,  vicious  and  criminal  classes  may  be 
avoided.  The  evils  of  intemperance  in  the  use  of  stimulants  or 
narcotics  are  so  great  that  men  whose  habits  in  this  respect  are  under 
suspicion  should  be  rigidly  excluded.  It  may  sometimes  be  difficult 
to  form  a  correct  opinion  of  the  character  of  the  applicant,  but 
"  long  indulgence  in  habits  of  intemperance  will  almost  surely  be 
indicated  by  persistent  redness  of  the  eyes,  tremulousness  of  the 
hands,  attenuation  of  the  muscles  —  particularly  of  the  lower  ex- 
tremities —  sluggishness  of  the  intellect,  an  eruption  upon  the  face 
and  purple  blotches  upon  the  legs."  In  the  drunkard,  the  face  and 
nose  are  often  congested,  with  dilatation  of  superficial  capillaries, 
producing  a  bloated  appearance ;  there  may  be  a  prominent  dropsical 
abdomen ;  the  pulse  is  soft  and  quick,  and  the  skin  hot. 


RECRUITING.  195 

VISION  AND  HEARING. 

Vision.  —  To  determine  the  acuity  of  vision,  place  the  applicant 
with  back  to  the  window  at  a  distance  of  20  feet  from  the  test  types. 
Examine  each  eye  separately,  covering-  the  other  eye  with  a  card 
(not  with  the  hand).  The  applicant  is  directed  to  read  the  test 
types  from  the  top  of  the  chart  down  as  far  as  he  can  see,  and  his 
acuity  of  vision  recorded  for  each  eye,  with  the  distance  of  20  feet 
as  the  numerator  of  a  fraction,  and  the  size  of  the  type  of  the  lowest 
line  he  can  read  correctly  as  the  denominator.  If  he  reads  the  20- 
feet  type  correctly,  his  vision  is  normal  and  recorded  20/20;  if  he 
does  not  read  below  the  3O-feet  type,  the  vision  is  imperfect  and 
recorded  20/30;  if  he  reads  the  I5~feet  type,  the  vision  is  unusually 
acute  and  recorded  20/15,  etc. 

Until  1908,  normal  vision  was  required  of  all  recruits,  with  few 
exceptions,  but,  in  that  year,  Banister  and  Shaw,  U.  S.  Army,  con- 
ducted a  series  of  experiments  which  tended  to  prove : 

That  a  perfectly  sharp  image  of  the  target  or  bull's-eye  is  not 
necessary  for  good  shooting. 

That  a  visual  acuity  of  20/40,  or  even  20/70,  in  the  aiming  eye  is 
consistent  with  good  shooting,  provided  the  soldier  is  able  to  accu- 
rately focus  both  sights  of  his  rifle. 

That  as  rifle  shooting  is  an  act  of  monocular  vision,  a  compara- 
tively high  standard  of  vision  is  necessary  for  one  eye  only. 

In  accordance  with  these  conclusions,  the  prescribed  minimum 
visual  requirements  in  the  U.  S.  Army  are  now  as  follows: 

"  i.  For  the  line  of  the  Army  and  for  the  Signal  Corps:  20/40 
for  the  better  eye,  and  20/100  for  the  poorer  eye,  provided  that  no 
organic  disease  exists  in  either  eye. 

"  Recruits  may  be  accepted  for  the  line  of  the  Army  when  unable 
with  the  better  eye  to  correctly  read  all  of  the  letters  on  the  20/40 
line,  provided  they  are  able  to  read  some  of  the  letters  on  the  20/30 
line. 

"  2.  For  the  Ordnance  Department  and  for  the  Hospital  Corps : 
20/70  in  each  eye,  correctible  to  20/40  with  glasses,  provided  that 
no  organic  disease  exists  in  either  eye." 

The  conclusions  of  Banister  and  Shaw  have  been  strongly  con- 
tested by  Major  R.  P.  O'Connor  (/.  M.  S.  I.,  Jan.-Feb.,  1911),  who 
maintains  that  the  first  requirement  for  accurate  and  rapid  shooting 
is  the  ability  to  see  the  bull's-eye  clearly  and  hold  the  sights  upon  it 


196  MILITARY    HYGIENE. 

while  the  trigger  is  pulled.  To  do  this  the  bull's-eye  must  be 
focused  clearly  by  direct  vision,  the  sights  being  seen  by  indirect 
vision,  the  front  one  appearing  but  slightly  blurred  in  the  center  of 
a  much  blurred  rear-sight  notch.  The  necessary  sighting  correc- 
tions cannot  be  made  intelligently  if  the  target  is  blurred,  and  the 
bull's-eye  cannot  be  used  as  a  unit  of  measure.  The  great  majority 
of  sharpshooters  and  expert  shots,  according  to  O'Connor,  have 
normal  vision  or  had  it  when  they  learned  to  shoot. 

The  ability  to  correctly  estimate  distances,  under  all  circumstances, 
forms  an  important  element  in  the  education  of  the  soldier,  and  is 
indispensable  to  become  a  good  shot.  It  implies  the  power,  as  one 
changes  position,  to  perceive  differences  in  the  clearness,  color  and 
shape  of  topographical  features,  details  of  uniform,  moving  bodies, 
etc.  This  is  impossible  for  anyone  with  a  20/40  vision  in  the  right 
eye  and  a  possibly  poorer  one  in  the  left  eye.  Shooting  may  be  an 
act  of  monocular  vision,  but  in  all  situations  where  a  quick  and 
accurate  estimate  of  distance,  speed  and  direction  is  necessary, 
binocular  vision  is  indispensable. 

There  are  two  special  reasons  in  modern  warfare  calling  for  acute 
normal  vision :  the  distant  and  hidden  enemy,  often  with  only  the 
head  showing,  if  anything;  and  the  inconspicuous  color  of  his  uni- 
form, blending  with  the  background. 

To  sum  up,  it  should  be  said  that,  although  it  may  be  necessary, 
at  times,  to  enlist  applicants  with  vision  below  20/20  in  order  to 
obtain  a  sufficient  number  of  recruits,  the  normal  binocular  vision 
should  remain  the  standard,  and  be  required  whenever  possible. 

In  the  examination  of  candidates  for  admission  to  the  United 
States  Military  Academy  and  of  candidates  for  commission,  whether 
from  the  ranks  or  from  civil  life,  the  vision,  as  determined  by  the 
official  test  types,  must  not  fall  below  20/40  in  either  eye,  and  not 
below  20/20  unless  the  defect  is  a  simple  refractive  error,  not 
hyperopia,  is  not  due  to  ocular  disease,  and  is  entirely  corrected  by 
proper  glasses.  Hyperopia  requiring  any  spherical  correction, 
anisometropia,  squint  or  muscular  insufficiency,  if  marked,  are  causes 
for  rejection. 

For  admission  to  the  United  States  Military  Academy,  as  well  as 
for  candidates  for  commission,  color  blindness,  red,  green,  or  violet, 
is  cause  for  rejection.  For  enlistment  it  is  only  a  bar  for  applicants 
for  the  Signal  Corps.  Total  color  blindness  is  exceedingly  rare,  but 


RECRUITING.  197 

partial  blindness,  that  is,  blindness  in  one  of  the  fundamental  colors, 
may  be  expected,  according  to  Seydel,  in  6  or  7  per  cent,  of  soldiers 
examined.  Violet  blindness  is  very  rare;  the  green  is  the  most  fre- 
quent, being  about  twice  as  common  as  the  red. 

Hearing.  —  To  determine  the  acuity  of  hearing,  place  the  appli- 
cant facing  away  from  an  assistant  who  is  20  feet  distant,  and  direct 
him  to  repeat  promptly  the  words  spoken  by  the  assistant.  If  he 
cannot  hear  the  words  at  20  feet,  the  assistant  should  approach  foot 
by  foot,  using  the  same  voice,  until  the  words  are  repeated  cor- 
rectly. Examine  each  ear  separately,  closing  the  other  ear  by  press- 
ing the  tragus  firmly  against  the  meatus.  The  examiner,  whose 
hearing  should  be  normal,  faces  in  the  same  direction  as  the  condi- 
date  and  closes  one  of  his  own  ears  in  the  same  way  as  a  control. 
The  assistant  should  use  a  low  conversational  voice  (not  a  whisper), 
just  plainly  audible  to  the  examiner,  and  should  use  figures,  names 
of  places,  or  other  words  or  sentences  until  the  condition  of  the 
applicant's  hearing  is  evident.  The  acuity  of  hearing  is  expressed 
in  a  fraction,  the  numerator  of  which  is  the  distance  at  which  the 
words  are  heard  by  the  candidate,  and  the  denominator  the  distance, 
in  feet,  at  which  the  words  are  heard  by  the  normal  ear ;  thus  20/20 
records  normal  hearing,  10/20  imperfect  hearing,  etc. 

Deafness  of  either  ear  constitutes  an  absolute  cause  of  rejection. 
A  slight  degree  of  deafness  in  only  one  ear  may  be  overlooked. 

Candidates  for  aviation  must  have  perfect  vision  and  perfect 
hearing.  The  ear,  particularly,  requires  to  be  examined  by  a  series 
of  special  tests  to  ascertain  the  functional  powers  of  the  vestibule 
and  semi-circular  canals,  and  the  state  of  the  sense  of  equilibrium. 

SPECIAL    DISQUALIFICATIONS. 

The  following  defects  and  conditions  are  the  most  frequent  causes 
of  rejection: 

Skin.  —  Chronic,  contagious  and  parasitic  diseases,  vermin,  chronic 
ulcers. 

Head.  —  Abrupt  depression  in  skull,  the  consequence  of  old  frac- 
ture; marked  baldness. 

Spine.  —  Curvatures,  caries,  abscess.  Lateral  curvature  is  cause 
for  rejection  when  it  exceeds  one  inch  to  either  side  of  the  line  of 
spinous  processes,  especially  when  it  throws  the  shoulders  out  of 
symmetry. 


198  MILITARY    HYGIENE. 

Ears.  —  Deafness  of  one  or  both  ears ;  all  catarrhal  and  purulent 
forms  of  otitis  media ;  perforation  of  tympanum. 

Eyes.  —  Defective  vision  in  either  eye;  conjunctival  affections, 
including  trachoma  and  entropion ;  strabismus,  disease  of  the  lach- 
rymal apparatus,  exophthalmos,  ptosis,  asthenopia,  nystagmus. 

Mouth,  Nose  and  Fauces.  —  Deformities  interfering  with  mastica- 
tion or  speech,  chronic  ulcerations,  fissures  or  perforations  of  the 
hard  palate,  hypertrophy  of  the  tonsils  sufficient  to  interfere  with 
respiration  or  phonation,  loss  of  voice  or  manifest  alteration  of  it. 
The  applicant  must  have  "  at  least  six  serviceable  molar  teeth,  two 
above  and  two  below  on  one  side  and  one  above  and  one  below  on 
the  other  side,  and  so  opposed  as  to  serve  the  purpose  of  mastica- 
tion." 

Obstruction  of  nostrils,  or  foul  discharges  indicative  of  ozena. 
Simple  atrophic  rhinitis  is  readily  curable.  Nasal  polypi  often  mean 
chronic  sinusitis,  but  are  not  a  bar  to  enlistment  if,  after  removal, 
the  sinuses  appear  free.  Sunken  or  scarred  nose  is  often  indicative 
of  syphilis,  while  a  red,  bulbous  nose  suggests  alcoholism  or  indi- 
gestion. 

Men  with  marked  hypertrophy  of  tonsils  should  be  accepted  only 
after  excision.  According  to  Le  Wald,  2  out  of  3  cases  with  hyper- 
trophied  tonsils  will  also  have  adenoids,  and  every  2  out  of  3  recruits 
with  adenoids  have  visible  changes  in  the  middle  ear.  All  large 
adenoids  should  be  excised  before  acceptance,  as  well  as  smaller 
masses  if  associated  with  pathological  changes  in  the  middle  ear; 
refusal  to  be  operated  should,  at  least,  disqualify  the  applicant  for 
the  artillery. 

Neck.  —  Goiter,  great  enlargement  or  ulcerations  of  the  cervical 
glands. 

Chest.  —  Diseases  of  lungs  and  heart,  especially  in  flat  or  narrow 
or  malformed  chest.  In  examining  the  heart,  care  must  be  taken 
not  to  ascribe  to  disease  the  hurried,  sharply  accentuated  action 
sometimes  due  to  nervousness,  fright  or  embarrassment,  or  the 
irregular  action  caused  by  the  excessive  use  of  tobacco.  Nor  should 
the  examiner  attach  undue  importance  to  the  soft  systolic  murmurs 
often  heard  in  growing  athletic  youths,  functional  and  temporary  in 
their  nature. 

De  Loffre,  in  his  examination  of  applicants  for  enlistment  at 
Columbus  Barracks  (Mil.  Surg.,  Sept.,  1910),  found  that,  out  of 


RECRUITING.  199 

1,000,  just  100  suffered  from  affections  of  the  heart,  namely,  18.64 
with  organic  cases  (rejected)  and  81.37  with  functional  cases  (ac- 
cepted). Of  the  organic  cases,  the  ratios  of  valvular  disease  were: 
mitral  regurgitation  12.28,  aortic  regurgitation  2.09,  mitral  stenosis 
1.23,  and  tricuspid  regurgitation  0.57.  Of  the  functional  cases,  the 
valvular  exhibited  murmurs,  in  order  of  frequency,  at  the  pulmo- 
nary, aortic  and  mitral  valves,  while  the  neurotic  were  marked  by 
arrhythmia,  tachycardia  and  irritability.  A  simple  murmur  at  a 
valve  was  called  functional  unless  hypertrophy,  dilatation  or  other 
physical  signs  were  present.  Osier  considers  that  "  with  an  apex 
beat  in  the  normal  situation  and  regular  in  rhythm,  the  auscultatory 
phenomena  may  be  practically  disregarded."  Simple  murmurs  with- 
out the  presence  of  other  physical  signs',  especially  those  referable  to 
the  mitral  valve,  may  often  be  overlooked,  but  not  until  the  effect 
of  sharp  exercise  has  been  observed. 

Abdomen.  —  Chronic  inflammations  of  the  gastro-intestinal  tract, 
including  diarrhea  and  dysentery,  and  other  diseases  of  contained 
organs ;  hernia  in  all  situations. 

The  experience  of  the  medical  examiners  at  Fort  Slocum  has 
led  them  to  believe  that  indirect  inguinal  hernia  among  enlisted  men 
is,  with  rare  exceptions,  always  congenital. 

Anus.  —  Hemorroids,  prolapsus,  fistula  and  fissures. 

Genito-urinary  organs.  —  Syphilis  in  all  its  stages ;  venereal  sores 
(both,  chancre  and  chancroid)  and  gonorrhea,  whether  acute  or 
chronic;  urethral  stricture,  balanitis,  phimosis,  undescended  testicle, 
orchitis,  hydrocele,  incontinence  of  urine ;  all  diseases  of  the  blad- 
der and  kidneys.  Varicocele  "  does  not  constitute  a  cause  of  rejec- 
tion unless  it  is  either  painful  or  so  large  as  to  interfere  with  loco- 
motion ;  "  it  frequently  occurs  among  the  most  robust  men  and  often 
without  their  being  aware  of  its  existence. 

Latent  syphilis  has  been  shown,  by  the  Wasserman  test,  to  be  so 
much  more  prevalent  than  was  formerly  believed  that  the  examiners 
of  applicants  for  enlistment  at  Fort  Slocum  (Mil.  Surg.,  June, 
1911)  consider  as  syphilitic  a  large  proportion  of  applicants  with 
perforated  nasal  septum,  slight  general  glandular  enlargement,  thick- 
ening of  radial  arteries,  recurrent  superficial  ulcerative  keratitis,  or 
marked  follicular  conjunctivitis  (trachoma). 

Affections  common  to  both  extremities.  —  Chronic  rheumatism, 
diseases  of  joints,  irreducible  dislocations  or  false  joints,  old  dislo- 


2OO  MILITARY    HYGIENE. 

cations  if  attended  with  impairment  of  motion  or  distortion  of  the 
joint,  severe  sprains,  synovitis,  badly  united  fractures,  caries,  necro- 
sis, atrophy  or  paralysis,  extensive  or  adherent  scars,  permanent 
contraction  of  muscles. 

Hands.  —  Webbed  fingers,  permanent  flexion,  extension  or  loss  of 
motion  of  one  or  more  fingers ;  loss  or  serious  mutilation  of  either 
thumb,  total  loss  of  index  finger  of  the  right  hand,  total  loss  of  any 
two  fingers  of  the  same  hand,  or  loss  of  the  second  and  third  pha- 
langes of  all  the  fingers  of  either  hand. 

Lower  Extremities.  —  Varicose  veins,  especially  when  attended 
with  edema  or  marks  of  ulceration,  knock-knees,  club  feet,  flat  feet, 
webbed  toes,  bunions,  overriding  or  marked  displacement  or  deform- 
ity of  any  of  the  toes,  hammer  toes,  ingrowing  nail,  corns  on  the 
soles  of  the  feet,  or  soft  corns  between  the  toes. 

The  shin-bone,  if  rough,  nodulated  and  tender,  suggests  syphilis. 

A  broad,  flat  sole  is  common  in  laboring  classes,  particularly 
among  negroes,  and  is  in  no  way  disabling.  In  the  flat  foot  which 
renders  a  man  unfit  for  service,  the  arch  is  so  far  gone  that  the 
entire  inner  border  rests  upon  the  ground,  with  the  inner  ankle  low- 
ered and  very  prominent,  and  the  foot  apparently  pushed  outward. 
Flat  feet  are  not  infrequently  the  result  of  a  tuberculous  process. 

IDENTIFICATION   RECORD. 

A  personal  identification  record  consisting  of  all  body  marks  indi- 
cated on  an  outline  figure  on  his  identification  card,  of  finger  prints 
and  photographs,  forms  also  part  of  the  examination  of  the  recruit, 
under  orders  issued  from  time  to  time  by  the  War  Department. 

This  record  is  very  important  as  it  affords  sure  means  of  identify- 
ing him  should  he  at  any  time  during  his  subsequent  service  be 
found  dead  or  unconscious.  It  is  also  a  perfect  method  to  identify 
deserters  or  men  fraudulently  reenlisting  under  assumed  names. 

Vaccination  Against  Small-pox  and  Typhoid  Fever. 
After  enlistment  the  recruit  is  vaccinated  on  the  left  arm  and 
given  his  first  typhoid  prophylactic  on  the  right. 


CHAPTER    XVII. 
EXERCISE. 

"  We  march  zvith  our  muscles,  run  with  our  lungs,  gallop  with  our 
heart,  resist  zvith  our  stomach  and  succeed  ivith  our  brain."  (Dr. 
Phillippe  Tissie.) 

Exercise  should  not  be  regarded  merely  as  an  amusement  or 
recreation,  but  also  as  an  obligation,  inasmuch  as  it  is  indispensable 
for  the  maintenance  of  body  and  mind  in  a  healthy  condition  and 
the  proper  performance  of  all  bodily  functions.  Correctly  applied, 
it  not  only  maintains  health,  but  corrects  physical  defects,  supplies 
deficiencies  by  strengthening  and  developing  our  organs  and  render- 
ing them  capable  of  greater  and  more  persistent  effort.  It  is  there- 
fore especially  needed  by  the  recruit  in  order  to  train  him  into  a 
strong,  agile  and  enduring  soldier  and  obtain  from  him  a  maximum 
of  useful  work. 

PHYSIOLOGY    OF    EXEBCISE. 

Exercise  is  generally  understood  to  mean  the  more  or  less  active 
contraction  of  voluntary  muscles. 

We  know  that  our  nervous  energy  and  consequent  capacity  for 
mental  and  physical  work  depend  upon  active  cell  metabolism,  that 
is,  constant  and  rapid  renovation  of  tissues.  The  most  vital  factor 
in  this  work  of  nutrition,  assimilation,  dissimilation  and  elimination, 
whereby  heat  and  energy  are  evolved,  is  oxygen.  Unless  the  blood 
be  thoroughly  oxygenated,  all  functions  suffer.  An  abundant  supply 
of  oxygen  to  the  tissues  is  the  great  end  of  exercise. 

When  voluntary  muscles  are  set  in  motion,  they  require  more 
blood,  especially  more  oxygen.  If  this  motion  be  active  and  con- 
tinued, or  becomes  violent,  the  need  of  oxygen  is  so  much  greater 
that  the  heart  is  stimulated  to  quicker  action  in  order  to  furnish  a 
more  rapid  flow  of  blood  to  the  contracting  fibres;  hence  the  in- 
creased frequency  of  pulse  in  exercise.  But  since  the  blood  obtains 
its  oxygen  from  the  lungs,  it  follows  that,  simultaneously  with  in- 
creased pulse,  there  must  be  increased  respiration,  increased  first  in 
depth  and  then  also  in  frequency.  Heart  and  lungs,  then,  are  func- 

201 


2O2  MILITARY    HYGIENE. 

tionally,  as  well  as  structurally,  very  intimately  connected,  and  any 
stimulation  or  disturbance  of  the  one  is  necessarily  felt  by  the  other. 

At  the  beginning-  of  active  exercise  more  venous  blood  is  returned 
to  the  heart;  the  right  ventricle  labors  to  empty  this  increased 
amount  into  the  resistant  lungs.  There  is,  in  this  first  stage,  a  rise 
of  blood  pressure,  indicated  by  the  labored  heart-beats  and  more  or 
less  breathlessness.  But  soon,  with  the  increase  of  body  tempera- 
ture, the  resistance  lessens ;  the  lungs  expand,  the  peripheral  vessels 
dilate,  sweat  breaks  out  and  the  blood  pressure  falls ;  the  heart 
pulls  itself  together,  adjusts  itself  to  the  respiration  and  the  so-called 
"  second  wind  "  is  established. 

The  muscles  are  the  main  furnace  of  the  body  and  the  principal 
source  of  our  body  heat.  When  at  work  they  are  supplied  with 
4  or  5  times  as  much  blood  as  when  at  rest,  consume  20  times  as 
much  oxygen  and  discharge  25  times  as  much  carbonic  acid 
(Cheveau  &  Arloing).  Their  contractions,  therefore,  must  exert 
a  profound  influence  on  all  the  organs  and  functions  of  the  body. 
As  a  general  rule,  the  absorption  of  oxygen  and  discharge  of  CO2 
proceed  pari  passu,  so  that  the  latter  gas,  as  stated  by  Macfie,  may 
be  considered  a  measure  of  the  intensity  of  the  fire  of  life.  The 
greater  the  muscular  activity  the  greater  the  respiratory  exchange, 
that  is,  the  intake  of  oxygen  and  discharge  of  CO2.  Thus  E.  Smith 
found  that  a  man  discharged  162  c.  c.  of  CO2  per  minute  when 
asleep,  and  841  when  walking  three  miles  an  hour,  or  more  than  5 
times  as  much.  This  respiratory  exchange  is  the  true  measure  of 
vital  capacity,  a  term  which  should  be  applied  not  to  the  capacity 
of  the  lungs,  but  to  the  respiratory  capacity  of  the  tissues.  The 
heat  generated  in  the  muscles  is  so  efficiently  distributed  by  the 
rapid  circulation  of  the  blood  that  the  temperature  of  the  body  is 
seldom  raised  more  than  a  degree  or  two.  Through  this  increase  of 
temperature,  the  hemoglobin  of  the  blood  yields  oxygen  more  abund- 
antly so  that  a  more  active  metabolism  of  the  tissues  is  rendered 
possible.  Physiologists  consider  a  temperature  of  102°  F.  (in 
rectum)  as  the  highest  that  can  be  produced  by  exercise  without 
abnormal  effects;  above  that  point,  an  irregular,  inefficient  pulse  is 
likely  to  result. 

The  main  factor  regulating  respiratory  movements,  as  well  as  the 
cardiac  beats,  has  been  shown  by  Yandell  Henderson  to  be  the  pres- 
sure of  the  COZ  in  the  blood,  as  ganged  by  its  pressure  in  the  pul- 


RECRUITING.  203 

monary  alveoli.  During  exercise  more  CO2  is  produced,  the  greater 
its  pressure  in  the  blood  and  its  stimulating  effect  upon  the  respira- 
tory center,  causing  increased  breathing  in  rate  and  depth.  This 
results  in  greater  ventilation  of  the  alveoli  and  the  prevention  of  a 
dangerous  accumulation  of  CO2  in  the  blood.  Thus  rapid,  deep 
breathing,  for  about  half  a  minute,  produces  a  condition  of  apncea, 
in  which  there  is  no  inclination  to  breathe,  owing  to  the  washing  out 
of  the  CO2  from  lungs  and  blood.  In  this  condition,  the  composi- 
tion of  the  alveolar  air  will  show  only  2  or  3  volumes  per  cent,  of 
CO,  and  19  or  20  of  oxygen,  instead  of  the  usual  5  to  6  volumes  of 
CO2  and  13  or  14  of  oxygen.  Henderson  found  that  even  a  slight 
reduction  of  CO2  in  the  arterial  blood  causes  a  marked  quickening 
of  pulse,  and  that  a  further  reduction  may  cause  extreme  tachy- 
cardia. Increased  tension  of  CO2,  on  the  contrary,  slows  the  action 
of  the  heart  and  increases  the  ventricular  output. 

The  dyspnoea  of  violent  muscular  exercise  is  doubtless  the  result 
of  the  accumulation  of  CO2  in  the  blood  when  not  adequately  relieved 
by  the  ventilation  of  the  lungs.  Contributory  causes  are  the  pres- 
ence of  other  waste  products,  especially  lactic  acid,  and  the  inability 
of  the  heart  to  respond  to  the  higher  demand  made  upon  it.  When, 
from  strenuous  muscular  effort,  the  pulse  and  respiration  have 
doubled  in  frequency,  it  will  be  noticed  that,  after  a  rest  of  a  few- 
minutes,  when  the  dyspnoea  is  all  over  and  respiration  has  returned 
to  its  ordinary  rhythm,  the  pulse  rate  continues  much  above  the 
normal ;  whence  we  may  conclude  that,  since  the  heart  does  not 
recover  its  normal  action  until  long  after  the  disappearance  of 
dyspnoea,  it  cannot  be  the  main  agent  in  its  production. 

The  principal  non-nitrogenous  extractives  in  muscles  are  glycogen, 
dextrin,  sugars  and  lactic  acid.  The  amount  of  glycogen  varies  in 
different  muscles,  its  rate  descreasing  in  proportion  to  their  activity. 
It  is  the  form  in  which  carbohydrate  is  stored  up.  By  muscular 
work  it  becomes  transformed  into  dextrin,  maltose  and  glucose  be- 
fore being  oxidized.  After  prolonged  activity  glycogen  may  disap- 
pear from  the  muscles,  but  not  until  it  has  disappeared  from  the 
liver,  which,  therefore,  must  be  a  supplying  organ.  . 

The  lactic  acid  of  muscle  (often  called  sarcolactic  acid)  differs 
from  that  obtained  by  the  fermentation  of  lactose,  by  rotating  the 
plane  of  polarized  light  to  the  right,  and  is  probably  derived  from 
the  glucose  of  muscle.  It  is  always  present  in  the  urine  and  appears 


2O4  MILITARY    HYGIENE. 

to  be  a  normal  constituent  of  the  blood.  Violent  exercise  causes  it 
to  be  present  in  muscles  and  to  be  actively  excreted  by  the  kidneys ; 
it,  likewise,  increases  the  amount  of  it  in  the  blood,  the  alkalinity  of 
which  is  thus  reduced.  Moderate  exercise,  such  as  walking,  even  if 
continued  for  hours,  does  not  increase  lactic  acid  in  the  urine,  while 
a  marked  increase  will  follow  a  run  of  2  or  3  minutes,  if  sufficiently 
vigorous  to  produce  dyspnoea.  It  appears  to  be  the  result  of  imper- 
fect oxidation ;  the  oxygen,  although  increased  during  hard  muscular 
work,  not  being  supplied  in  sufficient  quantity  to  prevent  its  forma- 
tion. As  soon  as  the  period  of  violent  activity  ceases,  lactic  acid  is 
quickly  oxidized,  so  that,  in  less  than  an  hour  afterward,  the  tissues 
have  returned  to  their  normal  state.  A  slight  increase  would  para- 
lyze the  nerve-endings  and  poison  the  muscles  of  the  cardio-vascular 
system  were  it  not  thus  promptly  destroyed  before  accumulating  in 
sufficient  quantity  to  produce  its  toxic  effects.  Burridge  suggests 
that  each  muscle  contains  within  itself  enough  creatin  to  neutralize, 
by  its  change  to  creatinin,  the  amount  of  lactic  acid  it  may  produce. 

This  increased  formation  of  lactic  acid  in  strenuous  exercise  is 
said  to  serve  a  very  useful  purpose  in  rendering  the  blood  more  acid 
and  thus  stimulating  the  respiratory,  center  and  the  heart.  Inas- 
much as  the  alveolar  carbon  dioxid  soon  falls  to  normal  or  even 
below  normal  after  violent  exercise,  it  is  held  that  increased  respira- 
tion cannot  be  due  to  carbon  dioxid  alone  (/.  H.  Ryffel}. 

According  to  Bohr,  lactic  acid  has,  like  CO2,  the  remarkable  effect 
of  reducing  the  affinity  of  the  blood  for  oxygen,  thus  becoming  a 
valuable  accessory  in  tissue  respiration ;  it  is  especially  when  the 
oxygen  reaches  the  capillaries  at  a  low  tension,  under  stress  of 
exhausting  exercise,  that  it  exerts  this  beneficial  power  of  turning 
out  the  oxygen  from  the  hemoglobin  of  the  blood. 

The  gentle  or  moderate  exercise  of  a  few  muscles,  for  instance, 
those  of  the  upper  extremity,  may  not  produce  any  appreciable 
fatigue,  or,  if  prolonged,  may  produce  only  local  fatigue  without 
respiratory  difficulty ;  but  in  all  violent  muscular  effort  there  is 
always  a  corresponding  disturbance  of  heart  and  lungs,  a  disturbance 
which  is  in  difect  ratio  to  the  sum  total  of  work  done,  and  therefore 
not  necessarily  proportional  to  the  degree  of  fatigue  felt;  thus,  as 
mentioned  above,  a  man  may  be  tired  with  hardly  any  increase  of 
pulse  or  breathing,  while,  on  the  other  hand,  he  may  run  up-stairs 
and  get  out  of  breath  without  muscular  fatigue. 


EXERCISE.  2O5 

It  is  readily  understood  that,  whenever  the  heart  is  spurred  on  to 
more  vigorous  effort,  not  only  the  working  muscles  are  benefited 
but,  through  the  greater  velocity  of  the  more  highly  oxygenated 
blood,  all  the  organs  and  tissues  of  the  body  receive  an  increased 
share  of  oxygen  and  other  nutritive  principles;  therefore  the  man 
who  walks  not  only  exercises  his  lower  extremities  but  his  brain 
and  liver  as  well. 

There  is  no  doubt  that  thinking  and  mental  work  are  good  exer- 
cise for  the  brain  and  necessary  to  a  normal  and  complete  develop- 
ment of  the  mind;  it  is  also  common  experience  that  muscular  exer- 
cise, by  insuring  an  active  metabolism  of  the  brain  tissue,  is  neces- 
sary for  our  best  mental  work;  but  body  and  mind  can  seldom  be 
vigorously  employed  at  the  same  time  or  in  quick  succession  success- 
fully. Mosso  has  proved  conclusively  that  mental  exertion  produces 
not  only  psychical  weariness  but  also  a  distinct  loss  of  muscle  power. 
The  onset  of  fatigue  is  much  more  rapid  after  severe  mental  strain ; 
conversely,  mental  application  is  much  more  difficult  after  severe 
muscular  exercise.  It  is  a  great  mistake  to  imagine  that  the  brain 
does  not  share  the  fatigue  of  the  body  and  that  a  physically  ex- 
hausted man  can  think  as  clearly  and  successfully  as  when  in  a  state 
of  rest. 

It  has  not  yet  been  conclusively  shown  that  mental  effort  affects 
in  any  appreciable  manner  the  metabolism  of  nitrogen,  phosphorus 
and  sulphur,  so  far  as  determined  from  the  urine.  The  pulse  rate, 
body  temperature  and  production  of  CCX  may  be  increased,  but  such 
increase  is  so  slight  and  so  often  absent  that  one  cannot  assert  that 
mental  effort  has  a  positive  influence  on  metabolic  activity  (Benedict 
and  Carpenter).  Mosso's  belief  that  more  blood  flows  to  the  brain 
in  mental  work  so  that  the  head  becomes  heavier,  has  not  been 
confirmed.  On  the  contrary,  the  experiments  of  E.  Weber  (endorsed 
by  Leonard  Hill)  show  that  mental  work  causes  a  determination 
of  blood  not  to  the  brain  but  to  the  abdomen ;  that  pleasurable  ideas 
and  feelings  send  the  blood  from  the  abdomen  into  the  peripheral 
parts,  and  that  during  muscular  exercise  the  venous  cistern  in  the 
abdomen  supplies  more  blood  to  the  limbs. 

The  influence  of  exercise  upon  metabolism  and  excretions  is 
obvious.  As  already  stated,  the  intake  of  oxygen  and  output  of 
CO2  are  immediately  raised  and  increased  in  proportion  to  the  work 
done,  the  necessary  energy  resulting  chiefly  from  the  combustion  of 


2O6  MILITARY    HYGIENE. 

carbohydrates  and  fats.  The  nitrogenous  excretion  is  not  sensibly 
affected,  being  dependent  upon  the  intake  of  nitrogenous  food.  The 
phosphates  in  the  urine  are  increased.  Albuminuria  is  found  in  all 
cases  of  vigorous  exercise,  even  after  short  runs,  and  increases  in 
proportion  to  the  extent  and  duration  of  subnormal  blood  pressure. 
It  has  been  observed  that  the  best  athletes,  that  is,  those  capable  of 
greatest  exertion,  always  pass  albumen  in  their  urine  after  contests 
in  sports,  such  as  rowing,  running  and  football.  This  may  be  due 
to  the  coincident  feeble  blood  pressure,  and  the  clogging  of  the 
kidneys  from  an  unusual  increase  of  waste  products. 

Forms  of  exercise.  —  Exercises  have  been  divided  into  exercises 
of  strength,  exercises  of  speed  and  exercises  of  endurance.  We 
might  add  a  fourth  category,  namely,  exercises  of  skill.  In  all 
games  and  sports  the  characteristics  of  these  several  classes  of 
exercises  are  more  or  less  combined. 

Exercises  of  strength,  such  as  wrestling,  lifting  weights,  tug  of 
war,  etc.,  demand  the  simultaneous,  sustained  action  and  whole 
force  of  many  muscles.  In  order  that  these  muscles  may  take  a 
very  firm  attachment,  it  is  necessary  that  the  chest  be  filled  with 
air  and  all  the  bones  of  the  trunk  strongly  fixed,  with  glottis  closed. 
This  fixation  of  the  trunk  requires  will-power,  a  special  effort.  The 
highest  blood  pressure  is  produced  by  a  prolonged  straining  effort, 
as  in  lifting,  the  contraction  of  the  muscles  partly  closing  the  lumen 
of  blood-vessels  and  increasing  the  peripheral  resistance;  but  this 
is  soon  overcome  and  followed  by  an  abundant  and  continuous  flow 
of  blood  into  the  muscles,  producing  all  the  conditions  necessary  for 
energetic  tissue  repair.  Exercises  of  strength  need  very  little  work 
of  co-ordination,  or  repetition  of  movement,  occasion  but  little 
nervous  disturbance  and  do  not  demand  great  brain  work;  in  other 
words,  "  they  increase  energetically,  and  even  violently,  the  working 
of  all  the  organs  of  the  body,  while  leaving  in  relative  repose  the 
nerve  centers  and  psychical  faculties."  * 

Exercises  of  speed  are  those  which  require  frequent  repetition  of 
movement;  the  muccles  are  not  called  on  to  act  with  their  utmost 
energy,  but  to  contact  and  relax  a  great  many  times  and  at  very 
short  intervals,  the  result  being  the  same  amount  of  mechanical  work 
performed  and  the  same  increased  activity  of  the  respiratory  and 
cardiac  functions  as  in  exercises  of  strength ;  but  experiments  have 

*  Physiology  of  Bodily  Exercises.     Lagrange. 


EXERCISE.  207 

shown  that  muscles  subjected  to  small,  frequently  repeated  contrac- 
tions, receive  less  blood  than  during  one  long-sustained  contraction ; 
therefore  the  nutrition  and  development  of  muscles  is  much  less 
marked  in  exercises  of  speed  than  in  exercises  of  strength ;  it  is 
noted  that  professional  runners  have  trim  legs  and  comparatively 
small  calves.  Furthermore,  Lagrange  also  calls  attention  to  the 
excessive  expenditure  of  nervous  energy  and  certain  phenomena  of 
exhaustion  produced  by  exercises  of  speed,  out  of  proportion  to  the 
quantity  of  mechanical  work  performed ;  a  state  of  nervous  excita- 
bility which  prevents  repose  and  sleep,  defective  nutrition  and  repair, 
and,  sometimes,  great  loss  of  weight. 

Exercises  of  endurance  are  those  in  which  the  muscular  effort  is 
moderate  and  the  movements  not  too  rapid,  but  in  which  the  work 
is  continued  for  a  long  time.  The  duration  is  subordinate  to  the 
power  of  the  lungs  and  heart,  and  the  intensity  of  the  nervous  energy 
which  actuates  them.  Walking  is  the  type  of  exercises  of  endurance, 
but  when  performed  up  a  steep  slope  may  become  an  exercise  of 
strength.  Rowing  over  a  short  course  is  mostly  a  work  of  speed, 
but,  in  a  long  race,  becomes  also  a  \vork  of  endurance.  In  these 
exercises  all  the  functions  are  stimulated  but  in  a  milder  way  and 
without  danger  of  violence  to  any  organ.  A  serious  objection  is 
that  they  do  not  excite  the  respiratory  movements  with  sufficient 
strength  to  expand  the  air-cells  and  increase  the  capacity  of  the 
chest.  They  are  also  rather  tedious  and  irksome  from  the  monotony 
of  the  same  movements  long  continued.  For  the  soldier,  marching 
is  the  most  important  of  requirements  and  he  should  be  diligently 
exercised  in  it  until  the  proper  degree  of  endurance  has  been 
attained. 

In  exercises  of  skill,  the  psychical  faculties  are  more  severely 
taxed  than  in  any  other  kind;  they  require  speed,  repetition  and 
accuracy  of  movement,  and  special  training  of  certain  sets  of 
muscles.  Their  effects  are  mainly  those  of  exercises  of  speed,  but 
as  moments  of  rest  are  more  frequent  and  the  strain  is  less  con- 
tinuous, they  seldom  give  rise  to  the  utter  prostration  which  occurs, 
for  instance,  in  running  and  rowing  races. 

Fatigue  may  result  from  the  active  use  and  consequent  exhaustion 
of  the  nerve  centers,  or  from  muscular  exertion,  or  from  a  com- 
bination of  both  causes.  The  part  played  by  the  psychic  factor  in 
producing  fatigue  should  not  be  overlooked;  thus  great  mental 


2O8  MILITARY    HYGIENE. 

worry  is  often  more  exhausting  than  strenuous  physical  exercise, 
and  the  exercise  which  requires  thought  and  attention  is  much  more 
fatiguing  than  mere  mechanical  work.  But  if  nervous  impressions 
may  greatly  aggravate  physical  fatigue,  they  are  also  capable  of 
greatly  alleviating  it,  as,  for  instance,  the  stimulating  effect  of  a 
lively  tune  upon  tired  troops,  and  of  the  sight  of  camp  after  a 
weary  march. 

On  the  other  hand,  muscular  fatigue  has  well  marked  depressing 
effects  upon  the  various  faculties  of  the  mind :  memory  fails ;  names 
of  things  and  places  are  temporarily  forgotten;  the  will  power 
weakens  and  may  be  unable  to  control  unreasonable  impulses 
whereby  men,  for  instance,  straggle  away  from  marching  columns 
or  are  seized  with  panicky  fear;  discipline  is  relaxed  and  the  morale 
loosened.  Hence  the  danger  of  engaging  in  battle  with  exhausted 
troops. 

Fatigue  acts  as  a  sedative  upon  sexual  instincts,  but  creates  a 
desire  for  alcoholic  drinks. 

In  physical  fatigue,  physiologists  tell  us,  the  stimuli  sent  out  from 
the  central  nervous  system  are  blocked  in  the  nerve-endings.  The 
causes  of  this  blocking  are  not  yet  clearly  known.  It  is  generally 
attributed  to  lack  of  oxygen  and  the  accumulation  of  waste  products 
such  as  carbon  dioxid  and  lactic  acid  in  the  blood.  Masso  has 
demonstrated  that  the  blood  of  a  fatigued  animal  produces  fatigue 
in  another  animal  into  which  it  is  injected.  It  has  also  been  shown 
that  during  hard  work  the  sweat  becomes  toxic,  and  that  the  toxicity 
of  the  urine  is  increased.  According  to  Burridge  (/.  of  Physiol., 
1910),  the  conditions  present  in  a  muscle  working  at  a  fairly  high 
rate,  are  the  continued  liberation  of  potassium  and  production  of 
lactic  acid,  together  with  lack  of  oxygen  and  increased  tension  of 
carbon  dioxid.  In  his  opinion,  the  early  stage  of  general  fatigue  is 
due  to  the  increase  of  potassium  salts  in  the  circulation ;  this  corre- 
sponds to  the  normal  physiological  fatigue  from  which  the  system 
rapidly  recovers  without  after  effect.  The  excessive  fatigue  of  over- 
worked muscles  corresponds  to  the  action  of  lactic  acid ;  should  this 
acid  be  present  in  the  free  state  beyond  the  merest  traces,  stiffness 
of  muscle  results ;  in  this  stage,  the  condition  of  the  muscle  is  more 
an  inability  to  relax  than  to  contract,  being  then  particularly  liable 
to  contracture  and  cramp. 

Experiments  made  to  determine  the  effect  of  oxygen  inhalations 


EXERCISE.  209 

on  muscular  exertion  seem  to  show  that  this  gas,  thus  used,  is 
beneficial ;  that  if  inhaled  before  strenuous  exercise,  it  facilitates 
the  performance  of  the  latter,  and  that  if  inhaled  after  exercise  it 
diminishes  the  existing  fatigue  and  distress.  Hill  and  Flack  .found 
that  it  allows  a  man  to  stand  a  much  lower,  as  well  as  a  higher 
tension  of  CO2  than  normal ;  that  quiet  breathing  of  oxygen,  before 
exertion,  gives  the  best  results,  causing  the  athlete  to  excel  by  en- 
abling him  to  stand  a  higher  tension  of  CO2  The  sprinter  who 
would  otherwise  suffer  from  a  temporary  asphyxia  benefits  from  a 
full  initial  supply  of  oxygen,  and  the  long  distance  runner  in  whom 
oxygenation  does  not  keep  pace  with  the  demand  of  the  muscles  is 
likewise  benefited  by  oxygen  inhalation.  It  is  also  possible  that 
oxygen  thus  introduced  in  the  blood  may  play  a  part  in  the  rapid 
elimination  of  lactic  acid. 

On  the  other  hand,  Cook  and  Pembrey  contend  that  the  amount 
of  oxygen  in  the  alveolar  air  is  so  little  affected  by  muscular  exer- 
cise, that  its  administration  is  of  value  only  when  the  conditions 
are  pathologic. 

EFFECT   OF  EXERCISE   ON  MUSCLES. 

The  voluntary  muscles  make  up  the  bulk  of  the  body.  They 
consist  of  fibers  which,  through  the  nerves,  contract  and  relax  in 
obedience  to  the  will,  thus  acting  upon  the  bones  and  producing  the 
various  movements  of  the  body.  Exercise,  that  is,  the  frequent 
contraction  and  extension  of  the  muscle,  especially  against  resistance, 
at  first  produces  (especially  in  fleshy  and  stout  men)  a  reduction  in 
the  size  of  it,  as  well  as  in  the  total  weight  of  the  body,  due  to  the 
melting  away  of  all  superfluous  fat ;  but  after  two  or  three  weeks, 
the  muscles  begin  to  increase  in  size,  hardness,  power  and  endurance. 
The  increase  in  size  is  due  to  the  more  active  growth  of  the  indi- 
vidual fibers  and  not  to  any  multiplication  of  their  number.  Syste- 
matic exercise  also  develops  a  quicker  command  and  more  perfect 
control  of  all  our  muscles  so  that  complex  movements  and  delicate 
manipulations  requiring  the  simultaneous  play  of  many  muscles 
become  easier  and  less  fatiguing.  Hence  the  alertness  of  the  trained 
soldier,  that  is,  his  power  to  respond  quickly  to  the  perceptions  of 
the  senses  and  execute  promptly  the  commands  of  his  officers. 

It  is  obvious  that  soldiers  do  not  require  great  strength  and  there- 
fore large  muscles.  What  they  need  is  suppleness,  skill  and  rapidity 


21O  MILITARY    HYGIENE. 

of  movements,  as  well  as  great  resistance  to  fatigue  and  disease. 
To  that  end  they  must  have  sound  lungs  and  heart,  and  well  trained, 
sufficiently  developed  but  not  excessive  muscles.  It  is  very  likely 
that  the  process  whereby  a  muscle  becomes  physiologically  hyper- 
trophied,  and  afterward  (when  the  training  is  discontinued)  again 
reduced  to  its  normal  size,  is  accompanied  by  a  loss  of  tonicity.  The 
endurance  of  a  muscular  fiber  depends  much  more  upon  this  tonicity 
than  upon  its  size,  and  the  soldier  with  medium  but  tense  and  firm 
muscles,  quickly  responding  to  the  stimuli  of  the  nervous  centers, 
is  the  one  who  will  march  furthest,  carry  his  equipment  with  least 
fatigue  and  handle  his  rifle  most  efficiently.  The  nimble,  hard- 
trained  medium-sized  soldier  will  always  (other  things  being  equal) 
circumvent  and  overcome  a  much  heavier  and  stronger  but  slower 
adversary.  To  obtain  the  optimum  tonicity  of  muscular  fiber  with- 
out material  hypertrophy  is  the  problem,  and  this  is  solved  by  a 
proper  combination  of  systematic  gymnastic  training  with  exercises 
of  speed  and  endurance,  and  sane  athletic  sports. 

Involuntary  muscles  are  also  strongly  affected  by  exercise,  their 
health  and  the  activity  of  their  physiological  processes  depending 
greatly  upon  the  work  of  the  voluntary  muscles. 

EFFECT    OF   EXERCISE   ON   THE  HEART. 

As  stated  before,  the  heart  is  concerned  in  any  form  of  exercise. 
More  blood  has  to  be  sent  to  the  working  muscles  and  the  heart 
must  supply  it  by  increased  contractions,  so  that  its  fibers,  like  those 
of  other  muscles,  undergo  a  more  rapid  oxidation  and  renovation. 
The  result  is  increase  in  size  and  power,  as  well  as  in  frequency  of 
beat.  The  ventricular  walls  become  thicker  and  stronger,  especially 
on  the  left  side,  and  the  whole  organ  enlarged  and  strengthened. 
This  strengthening,  with  or  without  enlargement,  is  a  normal  physio- 
logical process  and  must  be  one  of  the  most  important  aims  of  exer- 
cise, for  physical  power  necessarily  depends  upon  vigor  of  heart. 

Another  ordinary  and  normal  effect  of  strenuous  athletics  is 
temporary  dilatation  of  the  right  side  of  the  heart,  due  to  the  passive 
congestion  of  the  lungs  and  increased  intracardiac  pressure  existing 
in  the  primary  stage  of  muscular  effort.  To  this  dilatation  are 
chiefly  due  the  increased  size  of  the  heart  during  and  immediately 
after  a  hard  contested  game,  and  various  murmurs  often  heard  at 
that  time  over  the  cardiac  region. 


EXERCISE.  211 

The  accommodating  power  of  the  heart  is  enormous,  and  so  long 
as  the  strain  upon  it  is  not  excessive  and  prolonged,  it  recovers  itself 
without  ill  effect.  Thus  the  pulse  may  rise  to  160,  175,  even  to  200, 
without  permanent  injury,  provided  the  heart  be  given  time  to 
recuperate.  Even  a  dicrotic  pulse  following  strenuous  exertion  is 
not  rare  and  need  not  always  be  considered  a  dangerous  sign.  But, 
unless  the  training  has  been  carefully  graded  and  the  muscular  effort 
is  always  kept  within  physiological  limits,  there  is  constant  risk,  in 
violent  exercise,  of  incurring  the  dangers  of  overstrain. 

In  young  healthy  soldiers  and  students,  even  when  not  engaged  in 
active  athletics,  functional  and  temporary  murmurs  over  the  pre- 
cordial  region  are  common  and  their  significance  must  not  be  exag- 
gerated. They  are  often  the  result  of  training,  worry  and  excite- 
ment, and  disappear  as  the  subject  grows  stronger  or  returns  to 
quieter  conditions.  These  murmurs  are  almost  always  systolic  (with 
first  sound  or  immediately  after),  soft,  blowing  in  character  and 
heard  with  greater  frequency  at  the  base  of  the  heart,  although  like- 
wise common  at  the  apex.  Perhaps  the  greatest  number  are  heard 
over  the  pulmonary  area,  in  the  second  left  interspace,  close  to  the 
sternum.  They  have  been  ascribed  to  dilatation  of  the  pulmonary 
artery  (conus  arteriosus),  and  to  leakage  of  the  mitral  and  aortic 
orifices  due  to  temporary  dilatation  of  the  heart  and  unequal  tension 
of  the  valve  leaflets.  Unless  these  murmurs  are  accompanied  by 
cardiac  enlargement,  venous  engorgement,  dyspnoea  or  disease  of 
some  other  organ,  they  cannot  be  regarded  as  indicative  of  organic 
heart  disease. 

Dr.  R.  Tait  McKenzie,  professor  of  physical  education  in  the 
University  of  Pennsylvania,  found,  after  exercise,  74  murmurs  out 
of  266  young  men  in  apparently  good  health,  and  therefore  contends 
that  this  presence  of  murmurs  in  28  per  cent,  of  normal  young  men, 
even  on  slight  exertion,  should  lead  to  caution  in  determining  their 
significance  after  severe  strain  or  fatigue. 

Oswald  S.  Lowsley  (Am.  J.  of  Physiol.,  1911),  has  shown  the 
effects  of  all  forms  of  exercise  upon  blood  pressure.  Any  exercise 
sufficiently  active  to  cause  an  increase  of  pulse  rate  also  causes  a 
rise  in  systolic  and  diastolic  pressures,  the  former  being  greater  than 
the  latter,  so  that  it  is  evident  that  the  heart  beats  are  strengthened 
as  well  as  accelerated.  As  soon  as  fatigue  sets  in,  the  pressure  falls 
to  normal  and.  if  the  exercise  be  continued,  invariably  falls  below 


212  MILITARY    HYGIENE. 

normal,  the  systolic  more  rapidly  than  the  diastolic,  and  remains  in 
this  subnormal  stage  a  period  of  time  proportionate  to  the  strenuous 
nature  of  the  exercise.  The  pulse,  at  first  strong,  becomes  weaker 
as  the  pressure  falls ;  its  rate  which  always  increases  during  exer- 
cise, decreases  rapidly  after  it  but  seldom  falls  below  normal.  The 
subnormal  stage  of  blood  pressure  which  follows  short  but  violent 
and  exhausting  exercise,  lasts  much  longer  than  the  same  stage 
following  prolonged  but  moderate  exercise,  an  indication  of  more 
serious  strain.  Speed  exercises  such  as  basket  ball,  football  and 
running  races  are  particularly  liable  to  overstrain.  There  is  less 
strain  put  upon  the  circulatory  system  by  walking  a  number  of  miles 
at  a  moderate  rate  than  by  sprinting  a  hundred  yards  at  top  speed; 
in  the  former  case  the  depressed  blood  pressure  returns  to  normal 
in  about  30  minutes,  while  in  the  latter  case  it  may  take  three  or 
four  times  as  long.  Lowsley  proposes  to  determine  the  beneficial  or 
injurious  effect  of  exercise  by  the  extent  and  duration  of  the  sub- 
normal phase  following  it.  When  the  pressure  returns  to  normal 
within  60  minutes,  the  exercise  may  be  considered  as  lying  well 
within  hygienic  limits,  while  a  return  to  normal  delayed  beyond  2 
hours  may  be  regarded  as  exceeding  these  limits.  In  speed  or  other 
strenuous  exercises,  the  systolic  pressure  rises  about  40  mm.,  and 
the  diastoiic  25  mm.,  above  normal,  while  the  pulse  rate  is  increased 
from  65  to  80  beats  per  minute ;  this  is  followed  by  a  systolic  drop 
of  15  to  20  mm.  below  normal,  the  pressure  returning  to  normal  in 
from  two  to  three  hours,  but  sometimes  not  until  four  to  six  hours 
or  even  longer.  It  is  noteworthy  that  even  moderately  active  exer- 
cise, such  as  is  indulged  in  for  recreation,  is  invariably  followed  by 
a  decided  drop  to  subnormal. 

EFFECT   OF  EXERCISE   ON"  THE  LTJNGS. 

The  end  of  exercise  being  a  free  supply  of  oxygen  to  the  tissues, 
it  follows  that  the  organs  which  supply  this  oxygen  must  be  ade- 
quately developed  and  equal  to  the  demands  made  upon  them. 
Therefore  it  is  impossible  to  expect  stout  arms,,  vigorous  legs  and 
strong  heart  except  with  an  ample  chest  capable  of  large  expansion. 
During  exercise  there  is  a  largely  increased  absorption  of  oxygen 
'and  a  correspondingly  larger  production  and  elimination  of  carbon 
dioxid,  aqueous  vapor  and  other  waste  matters  ;  therefore  the  respi- 
ratory function  is  greatly  stimulated.  Thus  a  man  marching  fast 


EXERCISE.  213 

will  inhale  five  times  as  much  air  as  if  reclining,  at  rest.  This  means 
that  instead  of  breathing  16  times  a  minute  and  inhaling  30  cubic 
inches  of  air  at  each  inspiration,  or  a  total  of  480  inches  a  minute, 
he  will  breathe  so  much  more  frequently  and  deeply  as  to  inhale 
2,400  cubic  inches.  The  amount  of  oxygen  absorbed  during  an 
average  working  day  is  about  three  times  greater  than  during  a  day 
of  inaction.  During  severe  labor,  the  consumption  of  oxygen  and 
excretion  of  carbon  dioxid  and  aqueous  vapor  are  frequently  in- 
creased from  7  to  10  times.  Nothing  therefore  should  interfere 
with  the  free  play  of  the  lungs  during  work  or  exercise,  neither 
tight  clothing  nor  badly  suspended  or  ill-distributed  equipment. 

It  is  very  important  that,  in  all  exercises,  so  far  as  possible,  the 
breathing  be  through  the  nose.  The  nostrils  are  chiefly  for  the 
purpose  of  warming,  moistening  and  purifying  the  air.  Thus  air  at 
14°  F.,  in  passing  through  them,  is  warmed  to  77°  by  the  time  it 
reaches  the  throat.  Their  devious,  convoluted  course  and  extensive 
mucous  surfaces,  to  which  most  of  the  organisms  and  foreign  par- 
ticles in  the  inspired  air  adhere,  render  the  access  of  germs  and  dust 
to  the  lungs  very  difficult.  But  in  severe  exercise,  as  in  games  and 
races,  it  is  impossible  to  inhale  enough  air  through  the  nose,  and  the 
mouth  must  be  kept  open.  Under  such  conditions,  mouth-breathing 
can  be  done  with  impunity  or  even  with  advantage,  for  the  body 
temperature  is  then  more  or  less  above  normal,  and  colder  air  taken 
into  the  lungs  tends  to  cool  the  body  and  restore  the  equilibrium. 

Few  soldiers  know  how  to  expand  their  chests  properly  so  as  to 
fill  up  all  the  air  vesicles  and  take  the  fullest  advantage  of  their 
respiratory  capacity.  They  must  be  taught  the  proper  use  of  all  the 
respiratory  muscles,  including  the  diaphragm.  The  usual  tendency 
is  to  expand  chiefly  the  upper  part  of  the  lungs,  raising  the  clavicles 
and  shoulders,  but  complete  respiration  must  be  abdominal  as  well 
as  thoracic.  While  the  ribs  and  sternum  are  drawn  outward,  the 
diaphragm  should  be  correspondingly  depressed,  so  that  the  lower 
lobe  be  as  fully  expanded  as  the  upper  lobe.  The  shoulders  must 
not  be  perceptibly  raised.  The  Drill  Regulations  prescribe  that  the 
lungs  should  be  inflated  to  full  capacity  by  short  successive  inhala- 
tions through  the  nose,  and  emptied  by  a  continuous  exhalation 
through  the  mouth.  The  rhythm  should  be  as  nearly  normal  as 
possible,  that  is,  the  inspiration  followed  without  delay  by  the 
expiration ;  holding  the  breath  with  a  fully  expanded  chest  is  harm- 
ful to  heart,  lungs  and  abdominal  muscles  and  should  be  avoided. 


214  MILITARY    HYGIENE. 

In  taking  a  long  breath  the  downward  movement  of  the  diaphragm 
is  facilitated  by  contracting  the  abdominal  muscles  and  depressing 
the  shoulders.  According  to  Thooris,  the  strong  contraction  of  the 
abdominal  muscles  not  only  permits  a  greater  lowering  of  the  dia- 
phragm, but  also  increases  the  amplitude  of  the  chest  at  all  its  levels, 
while  preventing  too  rapid  an  inflation  of  the  lungs.  The  broad 
belt  often  worn  by  gymnasts  is  very  useful  in  this  connection  as  an 
abdominal  support.  Mobility,  more  than  the  size  of  the  chest,  is  the 
test  of  efficient  respiration,  but  it  must  be  entirely  due  to  the  move- 
ments of  the  thoracic  walls  and  not,  in  part,  to  the  forced  contrac- 
tion and  relaxation  of  the  muscles  of  the  chest  and  shoulders.  A 
true  mobility  of  3  or  4  inches  is  abundantly  capable  of  supplying  all 
the  oxygen  the  blood  can  possibly  absorb,  and  there  is  more  to  lose 
than  to  gain  in  attempting  to  increase  it.  Furthermore,  as  shown 
by  Hutchinson,  there  is  no  accurate  relationship  between  the  expan- 
sion of  the  chest  and  the  amount  of  air  inspired,  for  the  thorax  may 
be  uselessly  expanded  beyond  the  extensibility  of  the  lungs,  in  which 
case  the  abdominal  viscera  are  drawn  upward  to  occupy  the  vacant 
thoracic  space. 

The  expansion  of  the  lungs  is  best  promoted  by  exercise,  espe- 
cially marching  and  athletic  sports,  that  is,  all  muscular  efforts  which 
increase  the  rate  and  depth  of  breathing.  The  mere  practice  of 
deep  breathing  does  not  affect  the  metabolism  of  tissues,  and  there- 
fore does  not  generate  heat  nor  energy,  but,  nevertheless,  is  useful 
in  maintaining  and  increasing  the  mobility  of  the  chest  wall  and  the 
power  of  the  respiratory  muscles,  so  that  when  the  tissues  them- 
selves require  extra  oxygen,  the  lungs  may  be  fully  capable  to  obtain 
it.  Deep  breathing,  besides,  assists  the  circulation  of  the  blood  and 
lymph  through  the  thorax  and,  by  the  play  of  the  diaphragm,  mas- 
sages the  liver  and  other  abdominal  organs. 

Under  proper  military  training  an  increase  of  chest  measurement 
and  mobility  are  soon  noticed.  The  average  increase  in  size,  at  the 
end  of  the  first  year,  for  French  recruits,  is  about  an  inch  (Abel, 
Chassagne  and  Dally),  and  that  in  mobility,  according  to  Fetzer, 
very  little  less  (21  mm.).  The  vital  capacity,  in  the  experiments  of 
Fetzer,  rose  from  3  lit.  800  to  4  lit.  500;  Dettling  has  seen  it  reach 
5  and  even  6  liters  at  the  school  of  Joinville. 

The  classes  which  graduated  at  the  United  States  Military  Acad- 
emy in  1900,  1901,  1903,  1904  (346  cadets  in  all),  gave  a  measure- 


EXERCISE.  215 

ment  of  35.48  inches  at  expiration  and  37.78  inches  at  inspiration, 
\vith  mobility  of  2.30  inches.  At  the  time  of  entrance,  four  years 
before,  the  measurements  had  been  33.72  and  35.90,  respectively, 
with  2.18  mobility.  Therefore  the  increase  during  their  stay  at  the 
Academy,  as  the  result  of  natural  growth,  drill,  gymnastics  and 
athletics,  was  1.76  inches  at  expiration  and  1.88  at  inspiration,  the 
mobility  meanwhile  having  only  increased  0.12. 

The  class  which  graduated  in  1910  gave  measurements  of  33.7 
and  37,  respectively ;  at  the  time  of  entrance,  in  1906,  they  had  been 
31.75  and  34,  and,  in  1907,  32.60  and  36;  therefore  the  total  increase 
at  expiration  was  2  inches,  at  inspiration  3  inches,  and  in  mobility 
i  inch. 

For  the  period  1906-1910,  the  average  increase  of  the  fourth 
classmen,  from  October  to  June,  was  1.32  at  expiration,  1.52  at  in- 
spiration and  0.20  in  mobility,  corresponding  to  an  increase  in  lung 
capacity  of  16.34  cubic  inches. 

The  variations  in  the  above  figures  show  the  difficulty  of  compar- 
ing lung  measurements  with  a  view  to  formulating  definite  conclu- 
sions, unless  made  by  the  same  person  and  method. 

It  has  also  been  observed  that  the  effect  of  exercise  is  to  reduce 
the  number  of  respirations  and  increase  their  depth.  Thus  Marey 
has  seen  the  number  fall  from  20  to  12  a  minute  while  the  amplitude 
was  almost  quadrupled. 

EFFECT   OF   EXERCISE   ON   THE   SKIN. 

Exercise  causes  an  increased  supply  of  blood  to  the  surface  of  the 
body,  dilating  the  peripheral  capillaries  and  reddening  the  skin ;  at 
the  same  time  the  sweat  glands  are  stimulated  and  pour  out  an 
abundant  excretion.  From  the  more  active  oxidation  and  combus- 
tion of  the  tissues  produced  by  exertion,  the  body  temperature  is 
increased,  and  this  increase  would  soon  cause  serious  injury  to  the 
system  were  not  means  provided  to  check  it.  These  are  the  direct 
radiation  of  heat  from  the  congested  skin  and  the  evaporation  of  the 
sweat,  so  that  an  equilibrium  is  maintained  and  the  body  tempera- 
ture seldom  rises  more  than  i°  F.  above  normal.  As  sweat  con- 
tinues to  be  excreted  and  evaporated  after  the  exercise  ceases,  the 
temperature  soon  falls  to  normal,  or  even  below,  and  a  chilly  sensa- 
tion results  if  the  skin  is  not  properly  protected ;  hence  the  need  of  a 
sweater  or  woolen  garment  after  active  work.  Under  the  effect  of 


2l6  MILITARY    HYGIENE. 

strenuous  and  sustained  exertion,  during  a  game  or  race,  it  is  not 
unusual  to  see  the  temperature  fall  one  degree  or  even  more  below 
normal,  without  subsequent  ill  effects,  provided  the  young  athlete  is 
at  once  wrapped  up  in  a  blanket  and  allowed  to  recuperate. 

EFFECT    OF   EXERCISE   ON  HEIGHT   AND  WEIGHT. 

Height  is  sensibly  increased  by  exercise  in  young  men  under  20, 
especially  under  18,  but  it  is  doubtful  whether  that  of  young  soldiers 
(21  years  old  or  over)  is  perceptibly  affected. 

The  average  increase  of  height  of  the  four  classes  which  gradu- 
ated at  the  United  States  Military  Academy  in  1900,  1901,  1903  and 
1904,  during  the  four  or  more  years  of  their  stay  at  the  Academy, 
was  0.97  inch  (from  67.85  inches  to  68.82  inches).  Their  average 
age  at  entrance  was  slightly  over  19.  For  the  class  of  1910  the 
increase  was  only  0.70  (from  68.66  to  69.36).  The  greatest  rate  of 
increase  is  during  the  first  year,  the  period  of  compulsory  gymnas- 
tics, amounting  to  0.40  inch  as  the  average  of  the  fourth  classmen 
for  the  five  years  1906—1910.  The  rate  of  increase  thereafter,  to 
the  time  of  graduation,  is  much  less  marked;  thus,  for  the  1910 
class  (83  members),  the  height  was  68.66  in  1906,  68.89  m  I9°7  and 
69.36  in  1910.  After  graduation  (at  average  age  of  23  years),  the 
increase  in  height,  if  any  at  all,  is  a  negligible  quantity. 

Weight  is  quickly  and  markedly  affected  by  exercise.  In  the  first 
stage  there  is  almost  always  a  temporary  loss  ranging  from  a  few 
ounces  to  a  few  pounds,  but  this  is  readily  made  up  in  a  few  days 
by  a  more  active  digestion  and  greater  absorption  of  food.  This 
loss  is  due  not  only  to  the  oxidation  of  fat  and  glycogen  (or  its 
product,  alcohol),  but  also  to  an  increase  of  all  the  excretions,  espe- 
cially sweat ;  it  may  continue  or  increase  if  violent  exercise  is  per- 
sisted in,  without  sufficient  recuperation,  and  then  becomes  one  of 
the  signs  of  overtraining.  The  permanent  gain  in  weight,  the  net 
result  of  exercise,  varies  according  to  the  physical  condition  of  the 
subject,  being  much  greater  in  small  and  immature  than  in  large, 
well-developed  men.  This  probably  explains  the  striking  results 
obtained  in  the  training  of  recruits  in  certain  European  countries,  as 
compared  with  our  own  results.  Dettling  found  that  after  three 
months'  training  at  the  gymnasium,  the  young  soldiers  of  the  Join- 
vine  School  had  gained  2.425  kilos,  or  5.33  pounds.  Similar  figures 
are  recorded  by  other  German  and  French  military  gymnastic 


EXERCISE.  217 

schools.  According  to  Onslow  the  average  increase  in  British 
soldiers  who  completed  the  full  course  of  training,  in  1887,  was  2^2 
pounds.  In  this  country,  Butts  determined  that  after  a  course  of 
instruction  at  Columbus  Barracks  extending  over  a  period  of  $l/2 
months,  the  average  gain  was  2.81  pounds.  At  Harvard,  the  in- 
crease of  weight,  based  upon  a  class  of  200  men  averaging  18.3 
years,  after  6  months  of  moderate  work  in  the  gymnasium,  was  2 
pounds. 

At  the  United  States  Alilitary  Academy,  for  the  class  of  1910,  the 
total  average  increase  in  weight,  as  the  result  of  natural  growth, 
drill,  gymnastics  and  athletics,  during  the  four  or  more  years  of 
their  stay  at  the  Academy,  was  10  pounds  (from  139  to  149).  The 
greatest  rate  of  increase  is  during  the  first  year  (October  to  June), 
the  time  of  active  gymnastics,  amounting  to  6.29  pounds  (141.60  to 
147.89)  as  the  average  of  the  fourth  classmen  for  the  period  1906 
to  1910.  Thereafter  the  increase,  to  the  time  of  graduation,  is 
much  less;  thus,  for  the  1910  class,  the  weight  was  139  pounds  at 
entrance  (in  1906),  146.25  the  following  June,  and  only  149  in  1910. 

The  increase  in  weight  produced  by  exercise  is  almost  exclusively 
in  the  muscles,  which,  in  consequence,  become  harder  and  larger,  so 
that  there  is  a  gain  in  the  size  of  all  parts  of  the  body,  including 
chest,  shoulders,  hips,  upper  and  lower  extremities.  Thus,  at  the 
U.  S.  Military  Academy,  the  muscular  development  of  the  arms 
during  the  first  year,  as  averaged  for  the  period  1906-1910,  was  as 
follows:  the  right  and  left  arms  measured  9.68  and  9.54  inches, 
respectively,  in  October,  and  10.59  and  10.16  in  June.  The  only 
exception  is  in  the  waist  and  abdomen  which  become  reduced  in 
size,  much  of  the  fat  stored  in  these  situations  being  oxidized. 
Thus  Butts  found  that  the  average  loss  in  the  waist  of  recruits  was 
about  one  inch. 


CHAPTER  XVIII. 
EXERCISE   (CONTINUED). 

REGULATION   OF  EXERCISE. 

Young  soldiers  not  accustomed  to  systematic  training  have  but 
little  endurance  and  are  soon  tired  out.  Therefore  the  exercises 
should  be  easy  and  short  at  first,  gradually  increasing  in  duration 
and  intensity,  but  ceasing  as  soon  as  great  fatigue  is  noticed.  As 
the  training  of  the  recruit  progresses,  his  muscles  become  stronger 
and  his  joints  more  supple,  his  movements  are  better  coordinated, 
almost  automatic ;  he  feels  fatigue  less  and  less  and  becomes  capable 
of  strenuous  and  long-sustained  efforts  without  losing  breath  and 
without  exhaustion.  It  is  only  when  thus  perfectly  trained  that  he 
is  equal  to  the  physical  demands  which  are  made  upon  him  in  camps 
of  maneuvers,  in  the  field,  on  the  march  or  on  the  battlefield. 

The  rules  which  should  guide  instructors  in  drilling  recruits  may 
be  formulated  as  follows  : 

1.  The  exercises  should  be  progressive,  each  day  a  little  harder 
than  the  previous  day,  but  without  fatigue,  avoiding  violent,  sudden 
efforts  for  which  the  recruit  is  not  yet  prepared. 

2.  Each  man  should  be  examined  with  a  view  to  his  special  needs 
and  deficiencies,  and  placed  in  the  section  or  squad  where  he  may 
receive  the  training  most  appropriate  to  his  condition. 

3.  Agility  for  the  soldier  is  as  important  as  strength  and  should 
be  carefully  developed,  particularly  in  awkward  recruits  with  big, 
strong  muscles.    This  is  done  by  light  but  continued  exercises  espe- 
cially directed  to  the  suppling  of  joints,  and  calling  for  short,  quick 
movements. 

4.  Drills  should  take  place  in  the  open  air  whenever  possible,  or 
else  in  large,  well-ventilated  rooms.     The  maximum  time  devoted 
to  them  should  not  exceed  5  hours  a  day,  namely,  3  hours  in  the 
morning  and  2  in  the  afternoon,  with  a  sufficient  number  of  halts, 
during  which  the  men  should  be  allowed  to  stand  at  ease,  sit  or  lie 
down. 

5.  As  a  rule,  the  soldier  should  not  be  exercised  before  breakfast, 
or  such  exercise  should  be  short,  not  exceeding  half  an  hour.  The 

218 


EXERCISE.  219 

best  time  for  drill  is  between  meals,  that  is,  beginning  about  an  hour 
after  meal  and  stopping  soon  enough  to  allow  at  least  half  an  hour's 
rest  before  the  next  meal.  When  exercise  immediately  follows 
eating,  the  blood  which  is  indispensable  to  the  proper  work  of  the 
stomach  is  diverted  to  the  muscles  and  severe  indigestion  may  result. 
It  is  necessary  to  watch  over  the  digestion  and  to  bear  in  mind  that 
any  system  of  training  which  impairs  the  appetite  is  harmful.  The 
use  of  alcoholic  drinks,  or  other  stimulants  or  tonics,  before  or 
during  exercise,  should  be  strictly  prohibited. 

6.  The  action  of  the  heart  and  lungs  must  be  closely  watched,  and 
any  exercise  likely  to  bring  about  pulmonary  congestion  or  difficulty 
in  breathing  avoided.     No  exercise  should  be  so  strenuous  as  to 
produce  severe  dyspnoea,  while  the  pulse,  however  quick  it  may  be, 
should  remain  regular  and  of  fairly  good  strength. 

7.  Drills  must  be  made  as  varied  and  interesting  as  possible.    A 
long  continued  mechanical  repetition  of  the  same  movements  soon 
tires  the  recruit  and  renders  him  listless.     He  profits  but  little  by 
exercises  in  which  he  ceases  to  be  interested  and  which  he  performs 
in  an  imperfect  and  perfunctory  way.     Therefore  the  monotonous 
work  of  the  "  School  of  the  soldier  "  and  the  "  School  of  the  com- 
pany "  should  alternate  with  gymnastic  exercises,  marching,  wrest- 
ling, boxing,  fencing  and  athletic  games. 

Overtraining. 

When,  as  the  result  of  muscular  exercise,  carbon  dioxid  and  other 
waste  products  accumulate  in  the  blood,  we  experience  a  sense  of 
fatigue.  The  power  of  the  brain  to  generate  impulses,  as  well  as 
the  nerve  force  which  transmits  them,  are  weakened,  and  the  con- 
tractile power  of  the  muscles  is  impaired  so  that  the  heart  beats 
more  feebly  and  the  arterial  tension  falls.  If,  as  the  result  of  violent 
exercise  without  sufficient  rest,  these  waste  products  continue  to 
accumulate  faster  than  they  can  be  eliminated,  and  the  oxidized 
tissues  are  not  properly  renovated,  the  symptoms  of  overtraining 
show  themselves. 

The  most  common  form  of  overtraining  is  that  which  results  from 
continued,  hard  muscular  work  without  sufficient  rest  or  sleep,  and 
is  not  rare  among  soldiers  during  the  period  of  instruction,  maneuv- 
ers, practice  marches,  and  especially  during  a  campaign.  Its  symp- 


22O  MILITARY    HYGIENE. 

toms  are  constant  lassitude,  with  drawn,  haggard  face,  impaired 
appetite  and  disturbed  digestion,  loss  of  weight  and  strength,  fall  of 
temperature ;  the  heart  is  somewhat  dilated  and  the  pulse  soft  and 
quick,  while  the  cyanosed  skin  and  mucous  membrances  indicate  a 
sluggish  circulation.  In  this  so-called  "  stale  "  state,  soldiers  become 
an  easy  prey  to  infectious  diseases,  especially  typhoid  fever  and 
tuberculosis. 

In  another  form,  the  result  of  a  more  strenuous  but  less  prolonged 
exertion,  the  overtrained  men  suffer  from  myalgia,  lumbago,  general 
stiffness  and  well-marked  febrile  symptoms,  with  coated  tongue, 
gastric  disturbance,  headache  and  insomnia.  These  symptoms  usu- 
ally last  a  few  days  and  disappear,  but  sometimes,  in  more  aggra- 
vated cases,  the  patient  falls  into  a  typhoid  state,  the  so-called  over- 
training fever  (fievre  de  surmenage)  which  imitates  true  typhoid, 
being  distinguished  chiefly  by  the  normal  condition  of  the  respiratory 
organs,  the  weak,  dilated  heart,  cardiac  dyspnoea,  and  the  small, 
soft,  irregular  pulse. 

In  the  so-called  overstrain,  occurring  mostly  among  young  men 
taking  part  in  athletic  races  and  games,  the  symptoms  are  chiefly 
those  of  dyspncea,  caused  by  the  rapid  accumulation  of  waste  pro- 
ducts in  the  tissues,  and  cardiac  failure.  If  the  athlete  heeds  the 
first  warning  and  stops  in  time  he  soon  recovers  his  normal  condi- 
tion, but  if  he  prolongs  the  effort,  determined  to  win  at  any  risk,  he 
is  liable  to  the  worst  effects  of  overstrain  —  a  hypertrophied  and 
dilated,  flabby  heart,  with  irregular,  dicrotic  pulse  —  a  condition 
from  which  he  may  never  fully  recover.  In  other  words,  the  normal 
physiological  hypertrophy  of  the  heart  becomes  pathological.  In 
such  heart  the  persistent  increase  of  the  tension  to  which  the  seg- 
ments of  the  aortic  valve  are  subject  during  diastole  induces  a  slow, 
progressive  sclerosis  of  these  segments,  and  eventually  aortic  insuffi- 
ciency, causing  the  so-called  "  athlete's  heart." 

There  is  also  very  good  reason  to  believe  that  the  hypertrophied 
heart  of  the  athlete,  physiologically  adjusted  to  the  demands  of 
severe  training,  may  give  him  trouble  in  after  years,  when  he  settles 
down  to  a  quieter  life,  especially  if  he  fails  to  reduce  the  generous 
diet  to  which  he  is  accustomed.  As  a  rule,  the  enlarged  muscular 
fibre  of  an  athletic  heart  degenerates  gradually  to  its  normal  size  and 
gives  no  trouble,  but  there  are  exceptions  in  which  the  heart  retains 
its  abnormal  strength  and  vigor;  in  such  men,  according  to  Hare, 


EXERCISE.  221 

the  condition  is  comparable  to  that  of  a  steamer  whose  engines  are 
too  strong  for  her  hull.  As  noted  long  ago  by  Clifford  Allbutt,  the 
hypertrophied  left  ventricle  slowly  causes  stretching  and  dilatation 
of  the  aorta  with  subsequent  insufficiency  of  the  valves,  the  patient 
often  not  seeking  medical  aid  until  after  middle  life. 

One  of  the  most  frequent  evil  effects  of  violent  athletics  is  renal 
congestion  and  overstrain.  Albumen  is  often,  if  not  always,  found 
in  the  urine  after  severe  and  protracted  muscular  effort,  and  it  would 
be  well  if  this  symptom  were  taken  as  a  warning  that  the  kidneys 
are  taxed  dangerously  near  to  the  pathological  point  (see  page  205). 
Those  young  men  who,  in  their  normal  state,  before  training,  present 
traces  of  albumen,  should  refrain  from  all  athletic  contests. 

Gymnastics  and  Physical  Training.* 

Physical  training,  that  is,  the  system  of  exercises  which  enables 
us  to  use  our  special  senses  and  motor  organs  to  the  best  advantage, 
is  of  greatest  value  to  the  soldier.  Its  effects  may  be  summed  up 
as  follows:  The  superfluous  fat  and  water  are  eliminated.  There 
is  increased  size  and  tonicity  of  the  muscular  fiber,  and  increased 
muscular  power.  There  is  also  a  distinct  economy  of  the  nerve- 
muscular  mechanisms  of  respiration  and  circulation.  New  move- 
ment complexes  are  established  with  the  use  of  fewer  muscles  by 
the  correction  of  the  needless  tension  of  antagonists.  This  economy 
of  muscular  effort  prevents  excessive  metabolism  and  results  in  a 
decreased  output  of  carbon  dioxid.  The  exercise  which  at  first 
raised  the  pulse  to  120  and  generated  a  temperature  of  102°,  can, 
after  suitable  training,  be  performed  with  a  pulse  of  90  and  a  tem- 
perature of  100°.  The  trained  soldier  can  march  at  least  a  third 
further  than  the  untrained  recruit,  without  any  more  fatigue. 

The  exercises  of  the  gymnasium  are  susceptible  of  great  variation 
and  therein  lies  one  of  their  chief  advantages.  It  is  possible  so  to 
order  and  combine  them  as  to  contract,  to  any  desired  degree,  ever)' 
muscle,  tendon  and  ligament,  thus  securing  suppleness  of  joints  as 
well  as  development  of  tissues,  for  it  must  always  be  borne  in  mind 
that  agility  is  as  desirable  as  strength.  Simple  callisthenics,  without 

*  The  authorized  manuals  and  guides  for  the  physical  training  of  recruits 
are  Butts'  "  Manual  of  Physical  Drill,"  for  outdoor  and  parade  ground 
instruction,  and  Koehler's  "  Manual  of  Gymnastic  Exercises,"  for  indoor  or 
purely  gymnastic  work. 


222  MILITARY    HYGIENE. 

apparatus,  can  be  made  exceedingly  useful  and  should  never  be  over- 
looked. An  objectionable  tendency  in  the  gymnasium  is  to  give  a 
preponderant  share  to  the  exercises  of  the  upper  extremities.  The 
arms  are  vigorously  trained  as  in  suspending  or  supporting  the  body, 
and  often  made  to  usurp  the  office  of  the  legs ;  they  soon  become 
greatly  developed,  often  out  of  proportion  to  the  rest  of  the  body, 
this  development,  in  professional  gymnasts,  often  amounting  to 
deformity,  such  as  protuberant  shoulder-blades  and  round  back. 
The  legs,  served  by  powerful  muscular  masses,  are  capable  of  much 
work  with  little  fatigue.  A  man  who  runs  quickly  up-stairs,  or  up 
a  steep  slope,  performs  a  sum  of  work  which  far  exceeds  any  mus- 
cular effort  he  is  able  to  do  in  any  other  way  during  the  same  time. 

The  vital  importance  of  chest  development  need  not-  be  dwelt 
upon ;  on  the  size  and  shape  of  the  chest  depend,  to  a  great  ex- 
tent, the  capacity  and  vigor  of  lungs  and  heart.  The  best  way  to 
increase  the  expansion  of  the  chest  is  to  strengthen  the  so-called 
respiratory  muscles,  those  concerned  in  elevating  the  ribs  and  ster- 
num and  depressing  the  diaphragm.  l£  is  an  error  to  believe  that 
this  is  best  achieved  by  exercising  the  upper  extremities ;  experience 
shows  that  it  is  best  attained  by  the  exercise  which  compels  the 
deepest  inspiration  and  insures  the  most  complete  inflation  of  all  the 
pulmonary  vesicles ;  we  must  therefore  seek  to  increase  the  ampli- 
tude and  frequency  of  the  respiratory  movements.  These  move- 
ments depend  upon  the  intensity  of  the  respiratory  need,  while  the 
intensity  of  this  need  depends  on  the  quantity  of  mechanical  work 
performed  in  a  given  time.  The  sum  of  work  performed  by  a  mus- 
cular group  is  according  to  the  strength  of  this  group ;  the  legs 
possessing  three  times  as  much  muscle  as  the  arms,  can  perform 
three  times  the  amount  of  wrork  before  being  exhausted.  There- 
fore, it  is  chiefly  by  the  use  of  the  legs,  as  in  running  or  ascending 
slopes,  that  the  chest  is  to  be  developed. 

Another  advantage  of  gymnastic  exercises  is  that  they  are  easily 
watched,  regulated  and  controlled,  consequently  free  from  injury 
or  accident.  Thus  it  is  a  very  remarkable  record  that  during  the 
last  twenty  or  more  years  there  has  not  been  a  single  serious  injury 
among  the  cadets  in  the  West  Point  gymnasium.  Furthermore, 
gymnastics  can  be  carefully  graded  and  adapted  to  individual  wants 
so  that  overtraining  is  impossible.  There  is  no  question,  then,  that 
they  can  be  made  to  answer  fully  and  successfully  all  the  physical 


EXERCISE  (CONTINUED).  223 

needs  of  a  growing  youth  or  young  recruit.  They  are  performed  at 
the  word  of  command,  requiring  attention  and  prompt  obedience; 
this,  however,  is  not  an  unmixed  advantage,  for  exercises  under 
coercion  are  not  always  performed  with  alacrity  and  thoroughness ; 
they  are  more  like  work  than  play,  may  become  irksome  and  often 
fail  to  bring  out  will-power  and  nervous  energy.  This  is  why 
athletic  games,  with  their  greater  freedom,  variety  and  excitement, 
will  always  be  a  pleasant,  useful  and  necessary  addition  to  mere 
gymnastics. 

For  the  soldier,  gymnastics  are  not  only  for  the  purpose  of  devel- 
oping his  strength,  agility  and  endurance,  but  also  a  means  to  the 
end  of  overcoming  the  many  obstacles  which,  in  warfare,  will  stand 
in  his  way.  Therefore,  in  a  complete  system  of  physical  training, 
they  should  be  supplemented  by  those  special  exercises  requiring 
knowledge,  skill  and  self-confidence,  which  the  soldier  would  be 
called  upon  to  perform  under  the  actual  conditions  of  a  campaign. 
These  applied  gymnastics  have  the  advantage  of  requiring  but  few 
appliances,  only  such  as  can  be  improvised  in  a  post  or  camp. 
They  comprise  various  kinds  of  races,  jumping  ditches,  vaulting 
over  fences,  scaling  walls,  climbing  poles  and  trees,  walking  on 
narrow  boards  placed  over  ditches,  etc. 

Circular  33,  War.  Department,  of  May  6,  1908,  is  a  compilation  of 
purely  military  exercises  which  have  been  conducted  throughout  the 
Army  from  time  to  time  in  athletic  meets,  and  was  published  as  a 
convenient  guide  for  the  government  of  competitions.  It  consists 
of  91  "  events  "  covering  most  of  the  field  duties  of  soldiers  on  foot 
and  horseback,  conducted  in  competition,  and  therefore  in  an  attrac- 
tive and  stimulating  form. 

In  our  Army,  the  question  of  physical  culture,  outside  of  the  Mili- 
tary Academy,  has  not  yet  received  the  systematic  treatment  which 
it  deserves.  Gymnasiums  have  been  established  at  some  of  our  larg- 
est posts,  in  connection  with  the  exchanges,  but  exercise  therein  is 
entirely  voluntary  or  left  to  the  discretion  of  post  commanders. 
Existing  War  Department  orders  provide  for  garrison  training  and 
field  training.  Garrison  training  includes  gymnastics,  outdoor  ath- 
letics and  all  other  military  exercises  practicable  in  garrison.  Field 
training  includes  practice  marches,  camping  and  all  other  field  work. 
The  details  of  this  training  and  the  time  devoted  to  it  are  prescribed 
by  Department  Commanders. 


224  MILITARY    HYGIENE. 

It  seems  to  be  the  opinion  of  officers  who  have  given  special  atten- 
tion to  the  subject,  that  gymnastic  drill  should  be  made  compulsory 
for  foot  troops  and  discretionary  with  the  post  commander  for 
mounted  troops,  but  never  exceed  30  minutes  each  day. 

Physical  training  for  officers. —  G.  O.  No.  148,  W.  D.,  1910,  en- 
joins upon  all  officers  on  the  active  list  to  keep  themselves  in  fit 
physical  condition  to  perform  active  duty  with  troops  under  war 
conditions.  Regular  and  systematic  exercise  will  be  required  of 
them  by  their  immediate  commanders  under  the  supervision  of  the 
Department  Commanders. 

All  officers  on  the  active  list  (general  officers  excepted)  will  be 
examined  physically  once  a  year.  As  soon  as  possible  after  this 
examination,  all  officers  above  the  grade  of  captain,  not  physically 
found  disqualified,  will  take  riding  tests  of  thirty  miles  each  day  for 
three  consecutive  days.  "  One  of  the  rides  will  be  concluded  within 
six  hours  and  thirty  minutes,  and  two  within  seven  hours  and  thirty 
minutes  each,  after  starting,  all  to  include  proper  rests."  The  an- 
nual riding  test  for  officers  serving  in  the  tropics  will  cover,  in  the 
same  number  of  days,  two-thirds  of  the  distance,  and  in  two-thirds 
of  the  time  each  day. 

Field  officers  of  the  Coast  Artillery  Corps  will  take  a  marching 
test  in  lieu  of  the  riding  test,  consisting  of  a  march  of  fifty  miles  to 
be  made  in  three  consecutive  days  and  in  a  total  of  twenty  hours, 
including  rests.  The  marching  test  for  officers  serving  in  the  tropics 
will  cover,  in  the  same  number  of  days,  two-thirds  of  the  distance 
and  in  two-thirds  of  the  time  each. 

Field  officers  of  the  permanent  staff  corps  and  departments  who 
have  reached  an  age  and  rank  which  render  it  highly  improbable 
that  they  will  ever  be  called  upon  to  participate  in  active  field  opera- 
tions may,  upon  their  own  application,  be  excused  from  the  physical 
tests  above  described. 

This  riding  or  marching  test,  as  the  term  indicates,  is  not  intended 
as  an  exercise,  but  rather  to  show  whether  field  officers  are  physically 
fit  for  any  active  duty  they  may  be  called  upon  to  perform.  From 
the  medical  point  of  view  it  is  open  to  some  objections.  In  the  first 
place,  it  does  not  seem  rational  that  senior  colonels  and  junior 
majors,  with  a  difference  of  20  or  more  years  in  age,  should  be 
subjected  to  the  same  test.  All  men  above  50,  but  particularly 
above  60,  suffer  more  or  less  from  organic  degenerative  changes  and, 


EXERCISE  (CONTINUED).  225 

for  some  of  them,  the  test  is  a  dangerous  strain.  They  may  not 
know  the  nature  and  extent  of  those  changes,  and  a  medical  exam- 
ination cannot  always  reveal  them.  The  test  may  thus,  by  throwing 
strenuous  work  upon  enfeebled  organs,  aggravate  their  condition 
and  seriously  impair  the  efficiency  of  officers  who,  in  actual  war, 
would  have  successfully  discharged  all  the  duties  normally  devolving 
upon  them.  It  may  be  noted,  in  this  connection,  that  elderly  officers 
with  ripe  judgment  and  accumulated  experience,  and  whose  physical 
condition  is  normal  for  their  age,  are  too  valuable  an  asset  of  a  well- 
constituted  army  to  subject  them  to  the  risks  of  a  test  much  beyond 
anything  likely  to  befall  them  in  real  warfare. 

In  the  second  place,  there  is  no  doubt  that  field  officers  can  be 
induced  to  keep  themselves  in  proper  physical  condition  by  less 
strenuous  and  more  efficient  means,  namely,  by  regular  and  system- 
atic exercise  covering  a  certain  number  of  hours  weekly  or  monthly, 
varying  according  to  age  and  rank. 

In  the  Navy  and  Marine  Corps,  the  physical  test  is  based  on  dif- 
ferent principles  ;  it  partakes  more  of  the  nature  of  exercise  and  is 
apparently  free  from  objections.  All  officers  on  the  active  list  are 
required  to  take,  once  a  month,  a  walk  of  10  miles,  to  be  completed 
in  not  more  than  4  and  not  less  than  3^2  consecutive  hours.  In  the 
tropics  or  "  any  place  where  the  temperature  is  correspondingly  high 
at  the  time  of  the  exercise,  the  distance  walked  and  the  times 
required  shall  be  two-thirds  those  above  stated."  Before  taking  the 
first  monthly  walk,  in  each  year,  each  officer  is  examined  by  a 
medical  board  to  determine  whether  it  .can  be  taken  without  danger 
to  the  officer,  and  again  within  3  hours  after  completion  thereof. 
All  officers  are  excused  from  the  test  during  the  calendar  year  prior 
to  their  retirement  for  age. 

SPECIAL  EXERCISES. 

Marching. —  Marching  being  the  most  important  of  military  exer- 
cises will  be  the  subject  of  a  special  chapter. 

Manual  of  Arms. —  The  manual  of  arms  exercises  all  the  muscles 
of  the  body,  but  very  unevenly ;  those  of  the  shoulders,  arms  and 
chest  are  much  more  affected  than  those  of  the  lower  extremities, 
and  the  right  side  more  than  the  left.  It  is  an  imperfect  exercise 
and  develops  quickness  of  movement  more  than  strength. 

Setting-up  Exercises. —  The  six  setting-up  exercises  prescribed  in 


226  MILITARY    HYGIENE. 

the  Drill  Regulations  are  simple,  easily  performed  and,  if  all  prac- 
tised successively,  affect  all  the  muscles  of  the  body  pretty  evenly, 
correcting  the  tendency  to  muscular  asymmetry  and  defective  atti- 
tudes produced  by  the  manual  of  arms,  bayonet  and  saber  drills,  and 
fencing.  Each  exercise  should  be  short,  as  it  brings  into  play  only 
few  groups  of  muscles  and  soon  produces  great  fatigue. 

Fencing. —  This  is  one  of  the  very  best  and  most  complete  of  mili- 
tary exercises;  bringing  into  vigorous  play  all  the  muscles  of  the 
body,  expanding  the  lungs,  cultivating  agility,  quickness  of  decision, 
rapid  coordination  and  accuracy  of  movements.  It  is  a  violent  exer- 
cise, only  to  be  indulged  in  by  the  physically  sound  and  which  should 
be  carefully  graded.  A  serious  drawback  to  fencing  is  that  the  side 
of  the  hand  which  handles  the  foil  is  liable  to  become  somewhat 
hypertrophied,  the  muscles  of  the  shoulder,  arm  and  leg  on  that  side 
growing  larger  and  stronger ;  as  a  consequence  there  may  also  be 
some  degree  of  lateral  curvature,  with  concavity  toward  the  foil 
hand.  This  danger  is  prevented  or  corrected  by  fencing  -with  the 
left  as  well  as  the  right  hand. 

Sword  and  saber  exercises  are  similar  in  their  character  and  erffects 
to  fencing.  In  bayonet  exercise,  both  arms  being  employed,  the 
muscular  exertion  is  more  evenly  distributed. 

Running  Drill. —  This  drill,  like  double-time,  is  prescribed  by  in- 
fantry regulations  and  forms  part  of  the  soldier's  training,  but  it  is 
a  violent  exercise  requiring  careful  supervision.  At  first,  the  soldier 
should  run  in  light  garb  and  without  encumbrance ;  later,  his  arms, 
canteen  and  equipment  may  be  added.  The  distance  is  gradually 
increased  until  it  reaches  a  maximum  of  200  or  300  yards.  To  avoid 
the  danger  of  overstrain,  men  running,  especially  in  competitive 
races,  should  be  allowed  to  fall  out  at  will ;  men  with  signs  of  cardiac 
weakness  should  not  be  allowed  to  run  at  all. 

Equitation. —  Equitation  brings  into  play  the  muscles  of  the  basin 
and  the  lower  extremities,  while  it  has  but  very  little  effect  upon  the 
upper  extremities  and  chest.  Therefore  it  is  an  imperfect  exercise 
and  must  be  supplemented  by  gymnastics.  The  continuous  shaking 
and  jolting  to  which  are  subjected  the  abdominal  viscera,  if  not  ex- 
cessive, have  a  beneficial  effect  and  tend  to  improve  digestion  and 
nutrition.  This  exercise  should  be  practised  in  open  air  whenever 
the  weather  permits  so  as  to  avoid  the  breathing  of  the  more  or  less 
infected  tan-bark  dust  of  the  riding-hall. 


EXERCISE  (CONTINUED).  227 

The  dangers  of  equitation  are  the  production  of  hernia,  ptosis  or 
displacement  of  various  abdominal  organs,  and  hemorrhoids.  It  has 
been  accused,  but  without  proof,  of  causing  varicocele  and  varicose 
veins.  The  mounted  soldier  is  particularly  liable  to  furuncles  and 
ecthyma  in  the  region  of  the  buttocks,  the  result  of  local  infection ; 
daily  washing  and  clean  linen  will  prevent  their  occurrence.  Chafing 
and  excoriations  of  the  thighs  and  buttocks  are  more  or  less  inevit- 
able in  recruits ;  they  should  be  washed  with  boiled  water  and 
dressed  with  antiseptic  gauze. 

Swimming. —  Swimming  is  a  useful  accomplishment  as  well  as  a 
capital  exercise,  and  wherever  possible  should  be  practised  by  the 
recruit.  It  produces  contraction  of  all  the  muscles  of  the  body,  as 
well  as  free  expansion  of  the  lungs,  under  the  best  possible  con- 
ditions. It  has,  furthermore,  the  added  advantage  of  the  marked 
tonic  effect  of  cold  water,  while  the  skin  is  thoroughly  cleansed.  It 
is  somewhat  violent  and  should  be  carefully  graded  to  the  cardiac 
strength  and  power  of  endurance  of  each  man.  A  non-commis- 
sioned officer,  or  Hospital  Corps  man,  well  instructed  in  the  care  to 
be  given  cases  of  asphyxia  by  drowning,  including  artificial  respira- 
tion, should  always  be  on  hand  with  the  necessary  outfit. 

To  secure  the  best  effects  and  prevent  the  dangers  of  swimming, 
the  following  indications  will  be  found  useful : 

Salt  water  is  best,  but  if  a  river  or  pond  be  used  the  water  should 
be  reasonably  clear  and  free  from  organic  filth,  and  the  temperature 
not  below  65°  or  70°  F. 

Do  not  enter  the  water  while  perspiring  very  much  or  when 
chilled,  or  too  soon  after  eating ;  the  best  time  is  a  couple  of  hours 
after  meal. 

On  entering  the  water,  submerge  the  whole  body,  including  the 
head,  and  begin  swimming  at  once  to  prevent  chilling. 

Diving  and  swimming  under  water  may  injure  the  ear-drum  or 
otherwise  affect  the  hearing,  and  therefore  should  be  avoided  by  men 
whose  ears  are  not  perfectly  sound. 

Leave  the  water  before  feeling  exhausted  or  very  cold,  and  before 
the  legs  and  feet  show  signs  of  numbness. 

After  the  swim,  dry  the  skin  thoroughly  to  restore  circulation  and 
prevent  chilling. 

Hygiene  of  the  gymnasium  and  the  swimming  pool. —  In  the 
gymnasium,  exercise  more  or  less  violent  is  indulged  in  ;  breathing 


228  MILITARY    HYGIENE. 

is  increased  in  frequency  and  depth,  and  takes  place  through  the 
mouth  as  well  as  through  the  nose.  It  is  therefore  necessary  that 
the  air  should  be  as  pure  as  possible.  Such  purity,  however,  is  ren- 
dered difficult  by  the  conditions  generally  prevailing  therein,  espe- 
cially when  frequented  by  many  people.  Dust  is  freely  introduced 
in  various  ways  and  kept  in  perpetual  motion,  so  that  even  with 
proper  care  it  cannot  be  excluded  to  the  extent  possible  in  other 
buildings.  It  has  been  noticed  that  in  badly  kept  gymnasiums 
wounds  frequently  become  infected.  All  surfaces  should  be  hard 
and  smooth  so  as  to  be  easily  cleaned.  Only  wet  mops  or  vacuum 
cleaners  should  be  used.  Mats  and  mattresses  must  be  frequently 
shaken  or  beaten  outside,  and  renewed  as  often  as  necessary. 
Smoking  should  not  be  allowed  under  any  circumstances,  and  spit- 
ting only  permitted  in  specified  places  where  suitably  disinfected 
cuspidors  are  provided.  A  common  cause  of  danger  is  sudden 
chilling  during  perspiration  from  strenuous  exercise ;  this  is  guarded 
against  by  avoiding  drafts  and  by  the  use  of  sweaters.  The  tem- 
perature of  the  gymnasium  should  never  be  above  50°  or  55°  F. 
An  abundant  fresh-air  ventilation  is  absolutely  necessary.  Besides 
the  ventilators  which  always  remain  open,  a  free  wind  perflation 
through  the  windows  is  highly  desirable  during  recesses. 

The  swimming  pool  is  a  necessary  adjunct  of  a  well-equipped 
gymnasium.  It  affords  a  form  of  exercise  which  should  not  be 
neglected.  By  reason  of  the  large  capacity  of  such  pool  the  water 
can  seldom  be  renewed  more  than  once  a  week,  so  that,  if  used  by 
many  persons,  it  is  liable  to  more  or  less  pollution  and  may  become 
a  medium  of  transmission  for  infectious  disease.  However  pure  the 
water  when  admitted,  the  number  of  microbes  increases  rapidly  from 
day  to  day,  so  that  a  bacterial  count  of  100  per  c.  c.  the  first  day  is 
very  likely  to  be  100,000  the  sixth  day,  even  when  the  swimmers  are 
required  to  take  a  preliminary  shower  bath.  If  a  sufficient  supply 
is  available,  a  certain  amount  of  water  may  be  drawn  out  every  day 
from  the  bottom  so  as  to  carry  off  some  of  the  sediment,  and  after- 
ward replaced  by  fresh  water.  It  is  also  a  good  plan  to  remove, 
with  small  hand  pumps,  any  accumulation  of  hair  or  other  debris 
observable  on  the  bottom.  Once  a  week  the  tank  is  emptied, 
scrubbed  and  refilled. 

In  order  that  swimmers  may  have  a  place  to  spit  out  swallowed 
water,  and  also  to  prevent  drippings  from  running  back  into  the 
tank,  it  is  advisable  to  provide  a  shallow  trough  along  the  edges. 


EXERCISE  (CONTINUED).  229 

The  best  way  to  prevent  the  transmission  of  infection  in  the  swim- 
ming pool  is  to  sterilize  the  water.  It  has  been  found  that  the  ap- 
plication of  calcium  hypochlorite,  in  the  proportion  of  one  or  two 
parts  per  million,  is  entirely  satisfactory,  offering  a  cheap,  conveni- 
ent and  efficient  method  of  insuring  a  hygienic  pool.  In  the  above 
proportion  there  is  no  noticeable  odor  or  taste.  The  lime,  finely 
pulverized,  may  be  put  in  a  cheese-cloth  bag  and  dragged  about  the 
pool,  or  else  dissolved  in  3  or  4  buckets  of  water  and  the  superna- 
tant solution  siphoned  off  into  the  tank.  As  the  effects  of  this  puri- 
fication last  at  least  four  days,  it  is  enough  to  practise  it  once  a  week. 
No  swimmer  should  be  allowed  to  enter  the  tank  except  after  taking 
a  soap  and  water  shower  bath. 

Some  investigators  contend  that  complete  purification  of  a  pool 
used  by  many  bathers  requires  a  proportion  of  2  or  3  parts  of 
hypochlorite  per  million  and  that,  in  such  quantity,  it  becomes  ob- 
jectionable on  account  of  its  odor  and  its  irritating  effect  on  the  eyes 
and  mucous  membranes.  They  recommend,  as  preferable,  sulphate 
of  copper  in  the  proportion  of  one-half  part  per  million.  It  is  not 
irritating,  is  free  from  odor  and  cheaper.* 

Athletic  Games  and  Races. 

Games  and  races,  such  as  football,  baseball,  basket  ball,  la  crosse, 
cricket,  tennis,  running  and  rowing,  provide  the  natural  and  most 
pleasant  forms  of  exercise.  They  should  therefore  always  form 
part  of  a  well-regulated  system  of  physical  training  and,  when  kept 
within  proper  bounds  and  intelligently  supervised,  receive  every  en- 
couragement. There  is  no  doubt  that  the  best  effects  of  exercise 
can  be  obtained  from  them,  provided  the  contestants  are  physically 
sound  and  properly  trained. 

Athletic  games  give  useful  results  in  the  Army  only  in  so  far  as 
all  recruits  are  permitted  and  encouraged  to  indulge  in  them,  that  is, 
when  the  games  are  practised  in  a  general  systematic  way,  for  the 
benefit  of  all.  To  pick  out  a  team  in  a  garrison  from  a  few  excep- 
tionally strong  men  and  train  them  for  a  contest  with  a  similar  team 
from  another  garrison  may  lead  to  pleasant  and  exciting  diversions, 
and  to  that  extent  is  unobjectionable,  but  such  training  and  contest 
add  practically  nothing  to  the  physical  efficiency  of  the  company  or 
regiment  concerned.  This  tendency  to  make  spectacular  displays 

*Jour.  A.  M.  A.,  Sept.  25,  1915. 


230  MILITARY    HYGIENE. 

of  athletic  games  is  one  of  the  most  serious  objections  urged  against 
them,  for  instead  of  an  average  gain  among  all  the  men,  the  great 
majority  of  them  are  allowed  to  be  simple  idle  spectators,  while  a 
small  minority  are  strenuously  trained,  even  to  the  point  of  danger. 
It  is  doubtful  whether  those  who  participate  in  these  contests  derive 
from  them  any  physical  benefit  which  they  would  not  more  fully 
obtain  from  ordinary  gymnastics.  Thus  it  was  found  that  at  the 
United  States  Military  Academy,  the  football  players  of  the  grad- 
uating classes  of  1900,  1901,  1903  and  1904  only  increased  4.36 
pounds  in  weight  during  their  stay  at  the  Academy,  while  the  aver- 
age increase  for  the  four  entire  classes  was  5.62  pounds. 

For  these  reasons  the  War  Department  has  wisely  decided  that 
athletic  "  meets  "  between  posts  should  not  be  encouraged,  although 
they  may  be  permitted  once  a  quarter  between  the  units  of  the  post. 

Surgeon  General  Stokes,  U.  S.  Navy  (Annual  Reports  for  1911 
and  1912),  believes  that  competitive  and  spectacular  athletics  are 
undesirable  for  midshipmen.  In  his  opinion,  the  prolonged  rigor- 
ous course  of  training  necessary  to  excel  in  games  and  races  is  par- 
ticularly dangerous  in  its  after  effects  in  the  Navy,  under  the  con- 
ditions of  service  at  sea  where  active  exercise  is  impossible  and  the 
body  more  liable  to  the  degenerative  changes  of  age.  An  examina- 
tion of  the  medical  records  of  625  former  athletes  at  the  Naval 
Academy,  from  the  classes  of  1891  to  1911,  showed  that  9  had  died 
and  12  had  retired.  Of  these  21  casualties,  6  were  due  to  tuber- 
culosis, 8  to  mental  or  nervous  diseases,  2  to  alcoholism,  2  to  heart 
disease  (directly  attributable  to  track  and  crew  racing)  and  i  to 
injury  received  in  football  contest.  Of  the  remaining  604  in  ser- 
vice, 198  had  disabilities  of  sufficient  moment  to  be  of  official  record ; 
48  being  referable  to  the  heart  or  blood-vessels,  16  to  the  joints  and 
ii  to  the  kidneys.  About  17  were  tuberculous  or  had  had  symp- 
toms of  tuberculosis,  16  were  cases  of  neurasthenia,  25  of  appendic- 
itis and  15  of  hernia.  The  last  two  classes  of  disabilities  were  par- 
ticularly associated  with  football. 

The  above  rates  of  casualties  and  disabilities  are  not  any  greater 
than  those  occurring  among  non-athletic  midshipmen.  They  are 
practically  the  same.  But  it  is  contended  that  the  athletes  being  all 
exceptional  men,  especially  selected  on  account  of  their  size,  strength 
and  endurance,  should  show  a  much  better  record,  a  more  striking 
superiority  in  their  freedom  from  disabilities.  In  analyzing  the 


EXERCISE  (CONTINUED).  231 

character  of  these  disabilities  it  becomes  apparent  that  a  large  per- 
centage of  them  should  be  ascribed  to  the  overtraining  and  over- 
straining undergone  during  the  years  of  their  academic  life. 

As  stated  by  Gulick,  of  Harvard,  no  evidence  has  been  presented 
showing  that  the  selected  men  taking  part  in  spectacular  intercol- 
legiate athletics  are  benefited  in  health,  strength  and  vitality.  On 
the  ground  of  benefit  to  the  individual  there  can  be  no  defense  of 
the  present  system  of  competitive  athletics. 

Football. —  Of  football,  as  it  affects  body  and  mind,  there  is  a 
great  diversity  of  views.  That  it  is  a  dangerous  game,  attended 
with  many  injuries  of  all  degrees  of  severity,  is  generally  admitted. 
From  the  records  of  the  members  of  football  teams  who  graduated 
at  the  Military  Academy  from  1892  to  1903  (159  in  all),  it  appears 
that,  in  1905,  5  had  died  from  disease  (typhoid  fever  2,  cancer  i, 
malarial  fever  i,  and  acute  mania  i),  evidently  too  small  and  im- 
perfect data  from  which  to  draw  useful  conclusions.  At  that  date, 
7  had  not  yet  fully  recovered  from  injuries  received  while  playing 
football,  although  not  incapacitated  for  duty.  That,  like  all  violent 
athletics,  football  may  cause  a  breakdown  in  middle  life  is  main- 
tained by  competent  observers.  Not  enough  years  had  elapsed 
when  the  records  of  the  above  teams  were  examined,  to  judge  of 
any  possible  after  effects  upon  the  heart  and  lungs. 

As  regards  mere  physical  development,  better  results  can  be  ob- 
tained by  graded  gymnastics  and  less  strenuous  games.  At  the 
United  States  Military  and  Naval  Academies,  as  well  as  all  other 
educational  institutions,  it  is  detrimental  to  intellectual  culture  for 
the  folowing  simple  reasons 

1.  It  absorbs  time  which  the  athlete  should  devote  to  his  books. 
His  leisure  hours  are  no  longer  his  own ;  he  must  train  and  practise 
as  bidden,  whatever  may  be  his  class  standing  and  need  of  study. 

2.  It  produces  intense  fatigue.    An  exhausted  body  means  a  tired 
mind,  one  incapable  of  useful  study.     Each  game  involves  the  ex- 
penditure of  an  enormous  quantity  of  nervous  energy,  and  time  is 
required  to  recuperate. 

3.  It  causes  many  injuries,  from  which,  indeed,  the  athlete  gen- 
erally recovers  but  for  which  he  must  be  treated  in  hospital  for 
days,  weeks  or  months,  valuable  time  irrevocably  lost  to  him. 

The  effect  of  football  on  character  is  noteworthy.  It  is  obvious 
that  the  qualities  which  it  demands  and  develops:  attention,  sub- 


232  MILITARY    HYGIENE. 

ordination,  self-restraint,  clear  judgment,  prompt  decision,  pluck, 
etc.,  are  precisely  those  most  needful  to  the  officer  on  the  battlefield. 
Therefore  it  seems  a  logical  conclusion  that  this  game,  although 
somewhat  dangerous  to  the  body  and  rather  seriously  interfering 
with  the  curriculum,  may  be  tolerated,  if  not  encouraged,  at  the 
Military  and  Naval  Academies,  not  indeed  as  a  means  of  physical 
culture  but  rather  as  a  means  to  develop  useful  military  traits  of 
character. 

From  what  precedes  it  does  not  follow  that  football  is  suited  to 
soldiers  and  sailors.  Most  of  them  have  not  received  the  thorough 
training  which  is  indispensable,  and,  at  their  age,  such  training  is 
hard  and  often  impossible.  Furthermore,  they  are  less  capable  of 
the  self-control  and  subordination  absolutely  necessary  for  a  clean 
game.  The  result  is  that  when  soldiers  play  football  the  casualties 
are  likely  to  be  many  and  serious. 

In  colleges  and  other  institutions,  not  military,  the  serious  objec- 
tions existing  against  football,  as  now  played,  are  not  offset  by  com- 
pensatory advantages  and  the  game  should  be  radically  changed 
or  else  completely  banished  from  them 


CHAPTER  XIX. 
THE  MAKCH. 

Maurice  de  Saxe  taught  long  ago  that  it  was  much  more  im- 
portant to  exercise  the  legs  of  the  soldier  than  his  arms,  that  in  his 
legs  was  the  secret  of  the  success  of  a  campaign,  and  that  ability  to 
march  was  far  better  than  knowledge  of  the  manual  of  arms. 
Napoleon  is  credited  with  the  saying  that  battles  are  won  with  legs 
rather  than  with  arms.  In  modern  warfare,  everything  tends  to 
indicate  that  victory  will  continue  to  be  with  the  commander  who 
gets  first  in  position  with  the  largest  number  of  men. 

Marching  is  the  normal  exercise  of  infantry.  It  is  the  simplest, 
easiest  and  most  important  of  all  military  exercises,  but  also  the  most 
exhausting  on  account  of  the  enormous  amount  of  muscular  work 
performed,  especially  when  the  soldier  carries  his  equipment,  arms 
and  ammunition.  The  infantry  man,  therefore,  should  be  constantly 
and  persistently  trained  in  marching,  with  and  without  his  load, 
until  he  is  able  to  walk  15  to  20  miles  a  day,  with  arms  and  equip- 
ment, without  much  fatigue,  almost  automatically. 

The  effect  of  practice  on  marching  is  well  shown  by  the  experi- 
ments of  Dr.  Pembrey.  At  first,  marching  a  certain  distance  caused 
a  rise  in  pulse  of  72  beats,  in  temperature  of  2.2°  F.,  and  a  loss  of 
weight  of  2.y\  pounds.  After  3  weeks  of  training,  the  same  march 
only  increased  the  pulse  28  beats,  the  temperature  0.6°,  while  the 
loss  in  weight  was  under  2  pounds.  A  moderate  rise  of  temperature, 
in  marching,  as  during  any  form  of  exercise,  is  physiological  and 
beneficial,  favoring  chemical  changes  and  enabling  the  muscles  to 
do  their  work  more  economically.  According  to  Melville,  the 
optimum  temperature  for  marching  is  about  100.6°,  and  may  rise 
higher  without  ill  effects. 

It  is  the  general  experience  that  soldiers  on  the  march,  even  when 
subjected  to  many  discomforts  and  hardships,  are  in  better  physical 
condition  and  suffer  less  from  infectious  diseases  than  when  in  stand- 
ing camps.  Thus  in  Sherman's  march  to  the  sea,  which  lasted  about 
six  months,  the  sick  were  less  than  2  per  cent,  in  the  Georgia 
column,  and  between  3  and  4  per  cent,  in  the  Carolina  column  which 
was  operating  in  swampy  country  and  harassed  by  the  enemy. 

233 


234  MILITARY    HYGIENE. 

Any  march  exceeding  20  miles  in  24  hours  is  a  forced  march,  but 
soldiers  in  good  training  should  always  be  able,  when  circumstances 
require,  to  make  a  forced  march  of  25  or  more  miles.  "  The  maxi- 
mum for  a  day's  march  of  infantry  and  trains  may  be  assumed  at 
28  to  30  miles ;  a  repetition  of  this  performance  on  the  next  day 
cannot  be  counted  upon  unless  conditions  are  quite  favorable " 
(Field  Reg.)  One  of  the  most  remarkable  forced  marches  on 
record  is  that  of  Friant's  division  which  covered  78  miles  in  46 
hours,  and  the  next  day  (December  2)  fought  in  the  battle  of 
Austerlitz,  where  it  lost  40  per  cent,  of  its  strength  in  killed  and 
wounded.  Equally  remarkable,  on  a  larger  scale,  is  the  march  of 
the  Grand  Army,  in  1802,  from  Boulogne  to  the  Rhine,  400  miles  in 
25  days,  or  at  the  rate  of  16  miles  a  day. 

During  the  period  of  the  year  assigned  especially  to  practical  in- 
struction, as  determined  by  Department  Commanders,  existing  orders 
direct  that  there  will  be  "  one  march  in  each  month  of  not  less  than 
three  nor,  ordinarily,  more  than  six  days,  and  during  such  period 
commands  will  take  the  field  for  not  less  than  twenty-one  consecutive 
days." 

According  to  our  Regulations,  the  length  of  the  full  step,  in 
quick-time,  is  30  inches  measured  from  heel  to  heel,  and  the  cadence 
at  the  rate  of  120  steps  per  minute.  The  foot  is  moved  smartly, 
but  without  jerk,  straight  forward,  sole  near  the  ground,  the  knee 
straightened  and  slightly  turned  out ;  at  the  same  time  the  weight 
of  the  body  is  thrown  forward  and  the  foot  planted  without  shock. 
The  arms  hang  naturally,  the  hands  moving  about  six  inches  to  the 
front  and  three  inches  to  the  rear  of  the  seam  of  the  trousers.  In 
quick-time  the  soldier  marches  100  yards  a  minute  and  3  2-5  miles 
an  hour. 

In  double-time,  the  length  of  the  full  step  is  36  inches  and  the 
cadence  at  the  rate  of  180  steps  per  minute.  The  hands  are  raised 
until  the  forearms  are  horizontal,  fingers  closed  and  elbows  to  the 
rear.  The  knees  are  slightly  bent  and  the  arms  allowed  to  swing 
naturally.  This  is  not  a  marching  step  but  a  run,  and  is  too  exhaust- 
ing for  more  than  spurts  of  a  few  moments,  although  careful  train- 
ing may  enable  most  soldiers  to  keep  it  up  15  to  20  minutes. 

In  the  route-step,  the  men  are  not  required  to  preserve  silence  nor 
keep  step,  but  the  ranks  must  cover  and  preserve  their  distance. 

In  European  armies,  the  quick-time  step  is  the  same  as  in  our 


THE    MARCH.  235 

service,  except  that  in  Germany  it  is  31^2  inches  with  cadence  of  115 
steps  per  minute,  and  in  Russia  only  28  inches.  According  to 
Marey,  the  length  of  the  step  increases  with  the  cadence  up  to  150 
steps  per  minute  and  then  diminishes.  It  is  generally  recognized 
that  better  results  are  obtained  by  lengthening  the  step  than  by  ac- 
celerating the  cadence ;  this  is  done  by  inclining  the  body  forward, 
completely  extending  the  rear  leg  and  flexing  the  front  one. 

In  the  double-time  step  there  should  be  no  hopping  movement,  the 
center  of  gravity  being  maintained  as  much  as  possible  along  a  hori- 
zontal line ;  the  leg  should  be  flexed  as  the  foot  strikes  and  the  foot 
set  flat  upon  the  ground. 

The  military  step  is  more  fatiguing  than  the  ordinary  walking 
step ;  the  movements  are  more  rigid  and  constrained,  ease  of  carriage 
being  sacrificed  to  precision  and  uniformity.  The  body  is  erect 
and  the  legs  extended  or  only  slightly  flexed,  the  heel  touching 
ground  first,  followed  after  an  appreciable  interval  by  the  toes.  The 
progression  of  the  body  is  attended  with  a  succession  of  vertical  and 
lateral  oscillations  very  conspicuous  in  a  regiment  of  marching 
troops,  the  body  rising  as  each  foot  is  lifted  from  the  ground,  and 
swaying  to  right  and  left  as  the  corresponding  foot  is  set  down. 
The  vertical  oscillation  often  reaches  an  amplitude  of  two  inches,  a 
useless  waste  of  effort. 

The  military  step,  therefore,  however  desirable  on  the  parade 
ground  and  on  occasions  of  ceremony,  is  not  suited  to  marching  in 
the  field.  To  render  it  less  irksome  and  fatiguing,  the  body  should 
be  slightly  inclined  forward,  but  with  head  erect  and  chest  thrown 
out  to  favor  breathing ;  the  foot  moves  parallel  with  the  ground 
and  nearly  straight  forward,  being  raised  only  just  enough  to  clear 
obstacles ;  the  muscles  of  the  knee  are  relaxed  as  the  foot  strikes 
ground  (heel  and  toes  almost  simultaneously)  to  prevent  shock. 
The  feet  should  be  slightly  turned  out  to  increase  the  base  of  sup- 
port, but  this  eversion  must  not  exceed  an  angle  of  10  or  12  degrees 
so  that  the  foot  may  rest  in  its  normal  position,  namely,  on  heel,  ball 
and  outer  edge ;  beyond  this,  there  is  a  waste  of  muscular  effort  and 
the  foot  is  made  to  rest  too  much  on  its  inner  edge,  with  danger  of 
straining  and  flattening  the  arch.  Under  instruction,  the  vertical 
and  lateral  oscillations  of  the  body  can  also  be  reduced  to  a  minimum. 

Flexion  step. —  Carrying  these  indications  still  a  little  further,  we 
obtain  the  "  flexion  step  "  of  the  French  as  developed  by  De  Raoul, 


236 


MILITARY    HYGIENE. 


said  to  be  the  most  natural  route-step,  and  the  best  to  cover  long 
distances  with  the  least  fatigue.  It  is  that  generally  taken  by  tired 
laborers,  messengers  and  mail-carriers.  In  this  step  the  body  is 
bent ;  the  hips,  knees  and  ankles  are  flexed ;  the  feet  just  clear  the 
ground  and  move  parallel  with  it,  being  planted  flat,  heel  and  toes 
together.  By  leaning  the  body  forward,  the  center  of  gravity  is 


FIG.  33. —  Flexion  march  (Bradford). 

displaced  and  the  legs  follow  with  least  muscular  effort;  the 
greater  the  inclination  forward  the  greater  is  the  speed.  This  step, 
it  is  claimed,  enables  trained  soldiers  to  cover  a  distance  of  10  miles 
in  about  i  hour  and  45  minutes,  with  less  fatigue  than  in  double  the 
time  with  the  ordinary  step.  Against  it  the  objection  has  been  made 
that  the  continuous  extension  of  the  quadriceps  femoris  (fleshy  mass 
in  front  of  the  thigh)  will  ultimately  cause  a  larger  expenditure  of 
muscular  work  than  in  the  ordinary  walk.  A  useful  modification, 
suggested  by  Demeny,  consists  in  fully  extending  the  rear  leg  which 


THE    MARCH.  237 

thus  helps  materially  in  increasing  the  length  of  the  step  and  pro- 
pelling the  body  forward.  (Fig.  33.)  This  step  is  not  as  much 
used  as  formerly  in  the  French  Army. 

REGULATION  OF  THE  MARCH. 

The  length  of  the  average  march  for  infantry  and  for  mixed  com- 
mands consisting  partly  of  foot  troops,  is  15  miles  per  day,  with  a 
day  of  rest  at  least  once  a  week.  Small  commands  of  seasoned  in- 
fantry marching  on  good  roads  in  cool  weather  can  cover  20  miles 
per  day,  but  in  extensive  operations  involving  large  bodies  of  troops, 
the  average  rate  of  progress  will  not  exceed  12  miles  per  day. 
Field  artillery  marches  15  to  20  miles  a  day ;  cavalry,  after  men  and 
animals  are  hardened,  25  miles  a  day :  wagon  trains  about  the  same 
as  infantry.  (Field  Reg.) 

It  is  of  great  importance  that  an  even,  uniform  rate  be  maintained 
throughout  the  column,  so  as  to  avoid  the  alternate  checking  and 
hurrying  produced  by  an  irregular  pace,  so  fatiguing  for  the  body 
and  trying  to  the  temper.  In  the  field  the  maximum  rate  to  be 
counted  on,  while  marching,  is  3  miles  per  hour,  or,  including  halts, 
2^2  miles  per  hour.  "  Sandy,  muddy  or  slippery  roads,  great  heat 
and  dust,  strong  head  winds  and  storms,  or  broken  country  reduce 
the  rate  of  progress."  Under  average  conditions  the  rate  for  in- 
fantry columns  may  be  assumed  at  2^4  to  23/2  miles ;  thus,  for  a 
march  of  15  miles,  a  period  of  6  to  7  hours  is  necessary. 

After  marching  half  to  three-quarters  of  an  hour,  the  column  is 
halted  for  15  minutes  to  allow  the  men  to  relieve  themselves  and 
readjust  their  clothing  and  accoutrements.  After  this  first  rest 
there  should  be  a  halt  of  10  minutes  every  hour,  that  is,  the  troops 
march  50  minutes  and  then  halt  10.  This  is  not  a  rigid  rule  and 
may  be  modified  according  to  circumstances. 

Men  on  the  march  should  not  breathe  hurriedly,  but  regulate  the 
number  of  inspirations  to  the  cadence  of  the  step,  taking  a  deep 
breath  every  few  respirations  in  order  to  fill  all  the  air-cells  and 
secure  thorough  oxygenation  of  the  blood.  The  air  should  be  in- 
haled through  the  nose  as  far  as  possible,  but,  in  hard  marching, 
most  men  are  obliged  to  breathe  through  the  mouth  as  well. 

It  is  advisable  to  start  slowly  so  as  to  gradually  supple  the  joints 
without  fatigue  and  get  the  second  wind  established  without  breath- 
lessness.  It  is  likewise  well  to  slow  the  pace  at  the  end  of  the  march 


2j8  MILITARY    HYGIENE. 

so  as  not  to  get  into  camp  in  a  heated  and  perspiring-  state.  Halting 
places  should  always  preferably  be  on  clean,  dry  ground,  sheltered 
from  the  sun  in  summer  and  from  the  wind  in  cold  weather.  The 
men  should  be,  encouraged  to  lie  down  so  as  to  fully  relax  the  mus- 
cles and  place  the  body  in  the  best  position  for  prompt  recupera- 
tion. The  practice  of  massage  at  the  halts  is  often  advisable ;  it 
consists  in  the  forcible  flexion  and  extension  of  each  leg  three  or 
four  times,  followed  by  the  kneading  of  legs  and  buttocks  (C.  H. 
Melville}.  Such  massage  frees  the  muscles  from  the  waste  pro- 
ducts accumulated  in  them  and  prevents  cramp  and  stiffness.  If 
the  ground  is  wet  the  men  should  not  sit  or  lie  down,  unless  they 
can  do  so  on  their  ponchos  or  other  water-proof  material.  In  diffi- 
cult or  mountainous  country,  halts  should  be  more  frequent.  If  the 
march  be  unusually  long,  a  rest  of  about  one  hour  is  necessary  after 
covering  two-thirds  or  three-fourths  of  the  entire  journey,  during 
which  the  men  may  eat  a  light  meal. 

At  halts  the  company  commander  calls  out  the  side  or  direction 
where  the  men  may  attend  to  calls  of  nature ;  a  non-commissioned 
officer  designates  the  place  and  sees  that  the  feces  are  properly  cov- 
ered with  earth.  The  equipment  shovel  may  be  used  for  the  purpose. 
In  the  vicinity  of  dwellings,  a  small  trench  should  be  dug. 

"  When  the  roads  are  soft  with  mud  or  deep  with  sand,  it  may 
be  advisable  to  divide  the  column  longitudinally,  thus  permitting 
men  and  animals  to  pick  their  way  with  better  footing  and  leaving 
the  middle  of  the  road  clear.  The  suffering  from  heat  and  dust 
may  also  be  materially  reduced  by  this  method.  But,  whatever  the 
widening  of  the  column  thus  produced,  increase  of  length  of  the 
road  space  occupied  by  any  unit  should  not  be  permitted"  (Field 
Serv.  Reg.). 

The  moisture  evaporated  from  the  men  in  front,  in  a  marching 
column,  on  a  warm,  still  day,  saturates  the  air  so  that  the  men  in 
rear  may  suffer  much  discomfort.  This  is  relieved  by  the  division 
of  the  column  as  above  described,  as  well  as  by  changing  the  order 
of  march  from  day  to  day. 

The  composition  and  weight  of  the  equipment  and  clothing  on 
the  march  should  be  carefully  determined  by  the  commanding  offi- 
cer according  to  circumstances.  The  men  may  find  their  burden 
heavy  and  irksome,  especially  in  hot  weather,  but  should  be  made 
to  realize  that  each  one  of  the  articles  they  are  required  to  carry 


THE    MARCH.  239 

is  practically  as  essential  to  their  efficiency  as  rifle  and  ammunition. 
The  blanket  and  poncho  are  the  articles  most  likely  to  be  discarded, 
but  precisely  those  that  may  be  most  needed  in  the  cold  and  muddy 
bivouac.  If  the  march  be  through  a  malarial  country,  or  one  in 
which  dangerous  insects  or  poisonous  animals  are  known  to  be  com- 
mon, each  man  should  carry  his  mosquito-net  and  use  it  in  connec- 
tion with  the  shelter-tent  or  (in  the  absence  of  the  latter)  stretched 
over  his  couch.  It  will  protect  him  not  only  from  mosquitoes  and 
flies,  but  likewise  from  other  obnoxious  insects,  ticks,  scorpions  and 
reptiles. 

In  hot  weather  the  men  should  be  allowed  to  remove  their  coats 
or  blouses,  or  at  least  to  unbutton  them  so  as  to  promote  free  evap- 
oration of  perspiration. 

The  march  should  begin  at  as  early  an  hour  as  possible  so  that 
the  men  may  arrive  at  their  destination  by  noon  or  as  soon  there- 
after as  practicable.  In  hot  weather  or  in  a  tropical  climate,  an 
early  start  is  still  more  necessary ;  then  the  march  may  even  begin 
before  daylight,  being  intermitted  at  9  or  10  o'clock  and  the  troops 
allowed  to  rest  until  4  or  5  o'clock,  when  it  is  resumed.  Night 
marching  is  very  exhausting  and  justifiable  only  in  emergencies. 

The  men  should  breakfast  before  starting,  see  that  their  canteens 
are  full,  and  carry  their  luncheon  in  the  haversack.  Any  purification 
which  the  water  may  require  should  have  been  attended  to  the  pre- 
vious evening,  especially  boiling,  so  that  it  may  have  time  to  cool 
before  morning.  It  is  always  advisable  to  fill  the  canteens  in  the 
evening  and  leave  them  exposed  to  the  night  air.  All  forms  of 
alcoholic  drinks  are  pernicious  and  must  be  strictly  prohibited. 
Smoking  and  chewing  are  injurious  during  the  march  and  should 
be  postponed  until  the  camp  is  reached. 

Concerning  water  drinking,  thirst  is  not  an  entirely  reliable  guide. 
It  is  often  a  mere  expression  of  a  dry  condition  of  the  mucous  mem- 
brane of  the  mouth  and  pharynx,  or  sometimes  only  an  artificial 
craving  cultivated  by  indulgence  into  a  habit.  This  thirst  of  habit 
should  be  distinguished  from  true  or  physiological  thirst,  the  ex- 
pression of  a  real  water  hunger  of  the  tissues.  It  should  also  be 
noted  that  the  sensation  of  thirst,  like  that  of  hunger,  does  not  dis- 
appear as  soon  as  the  needs  of  the  economy  are  supplied  but  lingers 
for  some  time  afterward.  The  trained  marcher  drinks  moderately 
and  stops  promptly  as  soon  as  his  thirst  is  relieved  (not  quenched), 


24O  MILITARY    HYGIENE. 

thus  economizing-  water  and  strength.  Any  one  who  continues  to 
ingurgitate  water  so  long  as  the  process  affords  him  gratification, 
runs  the  risk  of  becoming  more  or  less  water-logged.  Such  unre- 
strained water  drinking,  especially  in  hot  weather,  produces  pro- 
fuse perspiration,  gastric  disturbance,  marked  debility  and  predis- 
poses to  heat-stroke  and  heat-exhaustion.  It  is  a  good  rule  not  to 
use  the  canteen  until  the  half-way  halt  is  reached.  The  careless 
soldier  who  drinks  early  in  the  day  creates  an  artificial  thirst  that 
must  be  frequently  gratified,  and  is  quite  likely  to  become  exhausted 
and  fall  out  before  the  march  is  completed.  Free  drinking  is  often 
the  result  of  alcoholic  indulgence,  injudicious  eating  or  excessive 
smoking,  conditions  which,  it  is  true,  call  for  plenty  of  water  but 
which  may  also  be  easily  aggravated  by  an  excess  of  it.  Outside 
of  such  abnormal  conditions,  free  drinking  is  physiologically  re- 
quired only  when  the  air  temperature  is  so  high  that  the  body  does 
not  lose  any  of  its  heat  by  radiation,  but  depends  altogether  upon 
evaporation  of  the  perspiration  to  maintain  its  temperature  down 
to  normal ;  then,  water  may  be  drunk  at  shorter  intervals,  in  suffi- 
cient amount.  Whenever  there  is  uncertainty  as  to  the  quantity 
and  quality  of  the  next  water-supply,  the  thoughtful  soldier  will  al- 
ways keep  a  reserve  in  his  canteen. 

According  to  Col.  Melville,  R.  A.  M.  C.,  even  the  untrained  man 
in  England  is  able  to  march  7  miles  without  drinking.  Thereafter 
he  should  have  a  pint  of  water  every  hour.  Every  soldier,  in  his 
opinion,  should  be  in  condition  to  cover  an  ordinary  day's  march  of 
14  miles,  on  a  fair  road,  without  having  recourse  to  his  water  bottle, 
but  needs  about  a  pint  every  hour  after  his  limit  of  endurance  is 
reached. 

To  relieve  thirst,  especially  the  thirst  of  habit,  the  chewing  of  a 
twig  of  some  bitter  shrub  or  of  a  piece  of  bark  is  recommended, 
as  it  excites  the  salivary  secretion  and  keeps  the  mouth  and  throat 
moist.  Weak  tea  or  coffee  in  the  canteen  is  often  better  than  water ; 
it  is  a  sterilized,  gently  stimulating  drink  and  less  of  it  is  necessary 
to  quench  thirst. 

Sugar  is  a  special  tonic  and  restorative  of  the  muscular  system, 
and  may  be  used  freely  either  in  coffee  or  tea,  or  in  the  form  of 
chocolate  tablets.  Coca  and  kola  have  been  praised  as  useful  mus- 
cular tonics  on  the  march,  but  without  sufficient  reason ;  coca  is  too 
dangerous  a  drug  for  soldiers,  and  inasmuch  as  the  active  principle 


THE    MARCH. 


241 


of  kola  is  caffein,  the 'same  result  can  be  more  easily  obtained  with 
tea  or  coffee  (see  page  413). 

The  sources  of  water  along  the  route  must  be  carefully  investi- 
gated by  medical  officers  marching  with  the  vanguard  and,  so  far 
as  possible,  their  quality  (whether  potable  and  safe,  or  otherwise) 
indicated  on  conspicuous  posters.  The  character  of  any  water, 
under  such  canditions,  can  only  be  determined  hurriedly  and  ap- 
proximately by  taste,  color,  smell,  surroundings,  depth  of  well, 


— — ^— — m  i  —     . ^ — Bl      ^^-^ »--~ 

FIG.  34. —  Army  water  wagon,  with  puinp,  hose  and  distributing  pipe. 


opinion  of  inhabitants,  etc.  The  men  should  be  forbidden  to  drink 
from  unauthorized  supplies.  To  insure  entire  compliance  with  such 
prohibition,  it  may  be  well  to  throw  a  few  grains  of  methylene  blue 
in  contaminated  springs  or  wells ;  the  deeply  colored  water  will  not 
be  touched. 


FIG.  35. —  Section  through  tank  of  Army  water  wagon. 

Before  crossing  desert  tracts  where  water  is  scant  and  of  bad 
quality,  a  sufficient  quantity  of  good  water  should  be  taken  in  bar- 


242  MILITARY    HYGIENE. 

rels  or  in  specially  constructed  carts.  The  army  water  wagon  re- 
cently adopted  by  the  Q.  M.  Department,  of  a  capacity  of  225  gal- 
lons (Figs.  34,  35)  fills  a  long- felt  want  and  will  doubtless  prove 
very  useful  under  such  circumstances. 

On  making  camp,  it  is  refreshing  and  comforting  to  take  a  bath 
whenever  practicable.  Even  where  water  is  scant  a  satisfactory 
degree  of  cleanliness  is  possible  by  means  of  a  sponge  or  wash- 
cloth. On  daily  marches,  it  is  not  advisable  to  wash  the  face  and 
neck  with  soap,  as  the  partial  removal  of  the  natural  oil  of  the  skin 
renders  it  more  susceptible  to  the  dust  and  heat  of  the  march ;  it  is 
enough,  morning  and  night,  to  rub  those  parts  with  a  damp  towel. 

CARE  OF  FEET. —  As  the  result  of  marching,  the  feet  are  liable  to 
various  injuries,  such  as  painful  arch,  corns,  blisters,  ingrown  nails, 
excoriations  or  abrasions,  synovitis  of  tendons,  tarsalgia,  etc.,  which 
may  be  followed  by  lymphangitis  and  adenitis.  When  walking  over 
rough  ground,  with  heavy  equipment,  there  is  also  a  liability  to 
sprain  or  even  fracture  of  metatarsal  bones.  These  injuries  are  pre- 
vented or  mitigated  by  the  use  of  well-fitting,  comfortable  shoes, 
rendered  soft  with  grease  or  oil,  and  by  cleanliness.  The  feet  should 
be  washed  every  day  by  immersion  in  cold  water,  but  only  long 
enough  to  remove  the  perspiration  and  dirt  and  relieve  the  sensation 
of  heat  and  fatigue;  long  soaking  softens  the  skin  and  does  more 
harm  than  good.  It  is  a  good  plan  to  change  shoes  every  day  or 
two ;  stockings  which  are  soiled,  wet  or  wrinkled  should  be  replaced 
by  a  clean  pair  as  soon  as  possible  or  else  dried,  cleansed  of  all  dust 
and  dirt,  and  kneaded  until  again  soft  and  pliable.  Careful  greasing 
of  exposed  or  painful  parts  with  fresh  tallow,  lanoline  or  vaseline,  is 
advisable.  It  is  also  recommended  to  soap  the  feet  or  dust  them  with 
talcum  powder,  before  starting,  to  diminish  friction.  Parts  exposed 
to  friction  may  be  protected  by  wide  strips  of  adhesive  plasters. 
Talcum  powder  (the  foot  powder  supplied  by  the  Medical  Depart- 
ment) consists  of  talcum  87  parts,  starch  10  parts,  salicylic  acid  3 
parts ;  it  is  a  useful  lubricant  and  antiseptic  and  generally  prefer- 
able to  grease  or  soap  on  foot  or  in  stocking.  Tender  feet  can  be 
hardened  by  bathing  them  in  alum,  lead  water,  or  diluted  alcohol. 

The  pied  force  of  the  French,  or  Fussgeschwulst  of  the  Germans, 
is  the  condition  produced  by  the  fracture,  partial  or  complete,  of 
the  second  or  third  metatarsal  bone,  at  the  junction  of  the  anterior 
and  middle  thirds.  The  symptoms  are  sharp,  localized  pain  and 


THE    MARCH.  243 

swelling,  rarely  with  ecchymosis  or  lymphangitis.  The  nature  of 
the  lesion,  unless  diagnosed  by  the  X-ray,  may  only  be  recognized 
by  the  presence  of  a  callus,  2  or  3  weeks  after  the  injury.  It  oc- 
curs in  marching  with  heavy  load,  especially  in  double  time,  or  in 
jumping  A  predisposing  cause  is  the  use  of  shoes  with  compara- 
tively high  heels  and  thin  soles,  as  in  the  German  and  French 
armies,  tilting  the  foot  forward  and  transmitting  the  shock  of  the 
step  directly  to  the  metatarsals. 

Bunion  is  an  enlarged  and  more  or  less  inflamed  bursal  sack  over 
a  joint,  most  commonly  the  metatarso-phalangeal  joint  of  the  big 
toe,  in  connection  with  hallux  valgus,  and  results  from  the  wearing 
of  narrow  and  pointed  shoes.  If  small  it  is  cured  by  the  use  of  a 
rational  shoe ;  if  large  and  swollen  the  man  should  be  discharged. 
Corns  should  be  pared  down  and  protected  with  corn  plasters ;  more 
radical  treatment  must  be  reserved  for  the  hospital.  Blisters  are 
pricked  with  a  needle,  gently  squeezed,  then  protected  with  adhesive 
plaster  or  bandage.  Care  must  be  taken  not  to  tear  off  the  raised 
cuticle.  Abrasions,  if  large  and  painful,  may  be  painted  with  a 
5  per  cent,  solution  of  chromic  or  picric  acid  ;  tincture  of  iodine  has 
also  been  recommended.  Toe  nails  are  not  so  likely  to  become  in- 
grown if  cut  square  across  or  only  slightly  rounded,  and  not  too 
close. 

Ingrowing  nails  are  often  very  painful,  incapacitating  soldiers  for 
marching.  They  are  promptly  relieved  by  a  wider  shoe,  but,  for  a 
few  days,  may  require  treatment,  consisting  in  trimming  the  nail 
and  inserting  a  pledget  of  cotton  under  its  offending  edge.  In  old 
cases  it  may  be  necessary  for  the  surgeon  to  remove  part  of  the  nail 
with  its  matrix. 

A  painful  arch  may  be  due  to  flat  feet,  or  to  weak  muscles  and 
ligaments,  or  perhaps  to  teno-synovitis.  It  may  require  to  be  sup- 
ported on  the  march  with  felt  pads,  adhesive  plaster  and  bandages. 
It  is  also  present  (says  Munson)  in  probably  a  majority  of  soldiers 
exercised  in  hard  marching  under  field  equipment  soon  after  being 
fitted  with  the  broad  army  shoe,  owing  to  the  stretching  of  muscles 
and  ligaments  in  adapting  themselves  to  the  new  conditions  of 
greater  foot  expansion.  Such  pain  wears  away  in  a  very  few  days. 

Teno-synovitis  is  a  painful  inflammation  of  muscle  tendons, 
usually  due  to  pressure  or  friction.  In  the  foot,  those  most  liable 
to  injury  lie  over  the  instep,  especially  the  extensors  of  the  toes. 


244  MILITARY    HYGIENE. 

The  tendo  achillis  also  frequently  suffers  from  blister,  abrasion  or 
inflammation  from  shoes  improperly  fitted  to  the  heel  of  the  foot. 

IRRITABLE  HEART. —  This  condition,  a  form  of  heart  strain,  is 
seen  in  young,  immature  and  untrained  soldiers,  and  appears  to  be 
the  result  of  temporary  dilatation  and  failure  of  the  right  heart, 
under  severe  and  steady  marching,  or  prolonged  nervous  and  mental 
strain.  There  is  more  or  less  exhaustion  and  shortness  of  breath ; 
the  action  of  the  heart  is  short,  irregular  and  "  irritable,"  that  is, 
greatly  quickened  by  the  least  exertion,  and  is  often  attended  with 
a  murmur;  the  pulse  is  weak,  intermittent,  quite  variable  in  fre- 
quency, sometimes  dicrotic.  The  treatment  is  complete  rest,  under 
which  the  patient  ultimately  recovers,  but  although  there  is  no  indi- 
cation of  valvular  disease  the  irritable  cardiac  action  usually  persists 
for  a  long  time. 

This  affection  is  reported  to  be  frequently  observed  on  the  battle- 
fields of  Europe  (1917). 

For  sunstroke,  heatstroke  and  heat-exhaustion,  see  under  Service 
in  Warm  Climates. 

WORK  DONE  IN  MARCHING. —  It  has  been  ascertained  that  an 
ordinary  day's  work  for  an  adult  is  equivalent  to  about  300  foot-tons 
a  hard  day's  work  to  400,  and  a  very  hard  day's  work  to  500  foot- 
tons.  From  the  investigations  of  Haughton,  Rubner  and  others,  it 
is  also  possible  to  estimate  the  amount  of  labor  performed  by  men 
in  marching.  According  to  Haughton,  as  quoted  by  Harrington, 
this  labor,  in  walking  over  a  level  surface,  is  determined  by  the 
following  formula : 

(W  +  W)  X  D 

X    C  =  number  of  foot-tons. 

2240  w       _  weight  of  the  person. 

W'      —  weight  carried. 

D        =  distance  in  feet. 

2240  =  number  of  pounds  in  a  long  ton. 

C        =  coefficient  of  traction. 

The  coefficient  of  traction  varies  for  different  rates  of  speed.  For 
two,  three,  four  and  five  miles  per  hour,  it  is  approximately  1/26, 
1/20,  1/16  and  1/14,  respectively.  Thus  a  man  weighing  160 
pounds,  carrying  40  pounds  and  walking  15  miles  at  the  rate  of  3 
miles  per  hour,  will  perform  an  amount  of  work  equivalent  to 
353-57  foot-tons: 


THE    MARCH.  245 


( 160  +  40)  x  79200       i 

X  — =353-57 


2240  20 

or,  if  at  the  rate  of  2.5  miles  per  hour,  307.45  foot-tons. 

The  nature  of  the  terrain  has  naturally  very  much  to  do  with  the 
amount  of  exertion  required ;  a  very  muddy,  sandy  or  dusty  road 
enormously  increasing  the  work  of  the  soldier.  He  may  even  be 
obliged  to  give  up  the  road  to  the  wagon  trains  and  pick  his  way 
alongside  of  it.  A  gently  rolling  country  is  better  for  him  than  a 
flat  surface,  as  all  the  muscles  concerned  in  locomotion  are  alter- 
nately brought  into  action  and  rested.  The  expenditure  of  energy 
is  generally  greatest  when  marching  over  rough  and  ascending 
ground.  If,  furthermore,  we  consider  that,  in  the  field,  marching 
is  only  part  of  the  day's  work  of  the  soldier,  that  he  must  also  pitch 
and  strike  camp,  load  and  unload  wagons,  do  guard  duty,  etc.,  we 
realize  that  an  average  daily  march  of  15  miles,  with  full  equip- 
ment, cannot  be  long  exceeded  without  danger  of  overstrain  and  of 
seriously  impairing  his  efficiency. 


CHAPTER  XX. 
PERSONAL  HYGIENE. 

The  mode  of  life  of  the  soldier  who,  in  camp  or  in  garrison,  is 
constantly  thrown  in  contact  with  his  comrades,  renders  personal 
cleanliness  and  good  sanitary  habits  especially  necessary. 

We  bathe  and  wash  the  skin : 

1.  To  promote  and  stimulate  its  physiological  functions.     These 
functions  are  of  great  importance.    The  skin,  besides  being  the  seat 
of  the  sense  of  touch,  is  an  excretory  organ,  pouring  out  from  one 
and  a  half  to  over  four  pints  of  sweat  daily,  and  the  regulator  of  the 
body   temperature.      It  also   contains   numerous   sebaceous   glands 
yielding  a  semi-fluid,  greasy  substance  which  forms  a  tenuous  lubri- 
cating film  over  many  parts  of  the  body.    The  sweat  holds  only  one 
or  two  per  cent,  of  solids,  consisting  of  sodium  chloride,  fatty  acids 
and,  in  case  of  disease  of  the  kidneys  or  liver,  some  of  the  waste 
products  normally  eliminated  by  these  organs.    The  evaporation  of 
the  sweat,  that  is,  its  conversion  into  vapor,  can  only  take  place  by 
the  absorption  of  heat,  chiefly  from  the  skin,  so  that  the  more  rapid 
the  evaporation  the  more  active  the  cooling  of  the  skin  and  the 
greater  the  reduction  of  the  body  temperature.     Washing  the  skin, 
therefore,  opens  the  pores  or  mouths  of  the  sweat  glands  and  pro- 
motes free  perspiration,  especially  during  muscular  exercise  when 
the  temperature  tends   to  rise.     It  also   stimulates   the   sebaceous 
glands ;  but,   on  the  other  hand,  repeated  bathing,   when  accom- 
panied by  hard  rubbing,  may  remove  their  secretion  more  or  less 
completely  and  cause  dryness  of  the  skin ;  this,  however,  is  seldom 
to  be  apprehended. 

2.  To  remove  dirt  and  prevent  the  breeding  of  germs  on  its  sur- 
face.   The  dead  superficial  layers  of  the  outer  skin  or  epidermis  are 
constantly   thrown   off  and,   togther   with   dried   sweat,   sebaceous 
secretion,  dust  and  other  outside  impurities,  fornr,  if  not  washed, 
a  foul  coating  which  affords  an  excellent  soil  for  the  growth  of 
microbes.    Remlinger  has  counted  40,000  on  a  square  centimeter  of 
skin.     Not  infrequently  they  cause  prickly  heat,  furuncles,  ecthyma, 
cellulitis,  whitlow,  etc.,  in  persons  careless  of  their  personal  habits. 

246 


PERSONAL    HYGIENE.  247 

Any  wound  of  a  dirty  skin  is  also  much  more  likely  to  become  seri- 
ously infected.  It  is  well  known  that  several  of  our  most  prevalent 
and  dangerous  infectious  diseases,  such  as  typhoid  fever,  cholera 
and  dysentery,  are  aften  propagated  by  personal  contact,  that  is, 
through  the  conveyance  of  infected  excretions  on  skin  and  clothing, 
but  especially  on  the  hands ;  hence  the .  increased  necessity,  in  the 
presence  of  one  of  these  infectious  diseases,  to  bathe  and  wash 
frequently. 

3.  To  prevent  fouling  of  the  air  by  emanations  resulting  from  the 
accumulation  and  decomposition  of  excretions  and  filth. 

4.  For  the  tonic  and  stimulating  effects  which  cold  water  produces 
on  the  terminal  filaments  of  nerves  and,  through  them,  on  the  whole 
nervous  system. 

DAILY  TOILET.  —  Every  man  should  wash  his  face,  head,  neck 
and  hands  every  morning,  in  cold  water.  Tepid  water  is  better  for 
cleansing  purposes  and,  if  available,  may  be  used,  but  should  always 
be  followed  by  cold  water.  Although  it  is  well  for  the  scalp  to  be 
washed  every  day,  soap  should  not  be  used  upon  it  more  than  once 
or  twice  a  week  for  fear  of  removing  too  completely  the  oil  which 
nature  provides,  and  making  the  hair  dry  and  brittle.  The  hands 
should  be  washed  with  soap  whenever  soiled,  before  each  meal,  and 
the  nails  frequently  cleaned  and  brushed. 

The  soap  used  on  the  human  skin  should  preferably  be  neutral 
in  reaction,  with  potash  base  and  a  slight  excess  of  fat  ready  to 
combine  with  the  alkali  set  free  as  the  soap  is  dissolved  (Unna}. 
The  water  should  be  soft,  that  is,  as  free  from  lime  and  magnesia  as 
possible ;  the  addition  of  a  little  lime-water,  soda,  glycerine,  bran  or 
starch  renders  hard  water  less  objectionable.  Soap  does  not  only 
act  as  a  detergent  in  removing  dirt,  but  has  also  considerable  bac- 
tericidal power  and  is  therefore  a  useful  disinfectant  for  the  skin 
as  well  as  for  soiled  linen.  This  action  does  not  appear  to  be  due 
to  either  the  alkali  or  the  fatty  acid  of  the  soap,  but  to  the  combina- 
tion of  the  two. 

The  mouth  and  throat,  particularly  when  the  seat  of  catarrh, 
ulcerations,  abscess,  etc.,  should  be  frequently  sprayed,  rinsed  or 
gargled  with  solutions  of  boric  acid,  borax,  chloride  of  sodium  or 
peroxid  of  hydrogen ;  Dobell  solution  is  a  popular  and  very  efficient 
preparation  for  the  purpose. 

The  teeth  demand  especial  attention.  As  soon  as  they  give  indi- 


248  MILITARY    HYGIENE. 

cations  of  decay  the  care  of  the  dentist  must  be  sought  so  that  they 
may  be  saved  if  possible.  The  preservaion  of  teeth  means  better 
health  and  probably  increased  longevity.  Tooth-picks  should  never 
be  of  metal  and  must  be  used  gently,  lest  the  gums  be  wounded  and 
become  infected.  The  tooth-brush  is  necessary,  but  should  be  com- 
paratively soft.  It  is  easily  contaminated,  not  only  from  the  mouth 
of  the  person  using  it,  but  also  from  exposure  to  extraneous  dirt, 
so  that  each  bristle  may  become  an  inoculating  needle.  It  is  well; 
therefore,  to  wash  it  thoroughly  after  using,  rinse  it  if  convenient  in 
a  mild  antiseptic  solution,  such  as  boracic  acid,  and  'then  keep  it  in 
a  bottle  closed  with  a  rubber  cork  into  which  the  end  of  the  handle 
is  permanently  stuck.  Such  bottle  is  particularly  desirable  while 
marching  or  traveling.  Hygienic  tooth-powder  should  contain  as 
little  hard  and  insoluble  matter  as  possible  in  order  not  to  bruise 
the  mucous  membrane,  or  lodge  between  the  teeth ;  ordinary  alkaline 
soap  is  preferable. 

The  nostrils  require  some  care ;  they  can  be  sprayed  daily  with 
Dobell  solution,  or  else  liquid  vaseline  or  a  tepid  solution  of  common 
salt  may  be  snuffed  up.  The  frequent  snuffing  of  cold  water  is  not 
advisable. 

The  ears  collect  much  dirt  and  should  receive  their  share  of  the 
daily  toilet.  Considerable  wax  is  often  secreted  at  the  mouth  of  the 
auditory  canal  and  should  be  removed  at  least  once  a  week;  this  is 
best  effected  with  a  little  absorbent  cotton  or  gauze  wrapped  around 
the  point  of  a  little  wooden  stick  or  tooth-pick  and  dipped  in  tepid 
water  or  diluted  alcohol ;  the  parts  must  be  wiped  dry  afterward. 
To  push  the  stick  deep  into  the  canal  is  unnecessary  and  dangerous. 

The  beard,  if  worn  at  all,  should  be  neatly  trimmed,  brushed  every 
day  and  frequently  washed.  It  is  best  for  the  soldier,  at  least  when 
in  barracks,  to  shave  the  whole  face,  although  the  wearing  of  the 
mustache,  if  properly  clipped,  is  unobjectionable. 

The  hair  should  be  kept  short,  less  so  in  the  tropics,  and  for  its 
ordinary  daily  care  needs  nothing  more  than  comb  and  brush.  Let 
the  brushing  be  free  but  not  so  hard  as  to  scratch  or  irritate  the 
scalp.  Once  or  twice  a  week  it  may  be  shampooed  with  soap  or  an 
alcoholic  lotion. 

It  is  well  known  that  contagious  diseases,  such  as  syphilis  and 
various  skin  affections  (tinea,  favus,  acne,  impetigo,  forms  of 
eczema,  etc.)  can  be  conveyed  by  the  hands,  instruments  and  imple- 


PERSONAL    HYGIENE.  249 

ments  of  the  barber.  Every  soldier,  therefore,  should  endeavor  to 
shave  himself.  But  as  this  cannot  be  enforced,  post  barbers  should 
be  required  to  keep  their  shops  and  their  persons  scrupulously  clean 
and  take  such  sanitary  measures  as  will  prevent  the  transmission  of 
disease.  For  the  disinfection  of  shaving  mugs,  scissors,  razors  and 
brushes,  boiling  water  is  efficient  but  somewhat  difficult  of  employ- 
ment. Alcohol  followed  by  a  solution  of  formalin  (4  per  cent.)  or 
tricresol  (i  per  cent.)  is  preferable.  Powder  puffs  should  be  re- 
placed by  wads  of  gauze  which  are  thrown  away  after  being  used. 

It  is  imperative  that  each  soldier  should  have  his  own  toilet  arti- 
cles, such  as  soap,  brushes  and  towels ;  if  he  does  not  shave  himself 
he  must  have  his  own  mug,  shaving-brush  and  razor  in  the  barber 
shop.  Roller-towels  should  be  banished  from  the  lavatory.  The 
use  of  toilet  articles  in  common  is  very  repugnant  to  cleanly  men 
and  insanitary ;  it  should  be  severely  forbidden.  As  a  rule,  only 
careless  men,  those  most  likely  to  transmit  infective  disease,  try  to 
borrow  such  articles.  Pipes  and  cigar  holders,  likewise,  must  be 
strictly  reserved  for  their  owners. 

The  feet  get  soiled  very  quickly,  not  only  from  outside  dirt  but 
also  from  their  own  secretions,  the  product  of  numerous  sweat  and 
sebaceous  glands.  These  secretions,  especially  between  the  toes, 
unable  to  escape,  collect  and  soon  form  a  culture  medium  for  many 
micro-organisms,  some  of  which  produce  the  repulsive  smell  so 
noticeable  in  certain  individuals.  Furthermore,  the  retained  sweat 
soaks  the  epidermis,  softens  it  and  renders  it  more  liable  to  rapid 
abrasion. 

The  feet  should  be  washed  whenever  the  body  is  bathed,  that  is, 
at  least  twice  a  week,  but  whenever  convenient  facilities  exist  it  is 
a  good  practice  to  wash,  them  in  cold  water  every  morning.  Soldiers 
who  do  much  walking  or  marching,  especially  in  the  field,  should 
bathe  them  every  afternoon,  after  getting  into  camp,  as  already 
noted.  In  case  of  great  tenderness  of  the  epidermis,  very  little  soap 
should  be  used,  and  only  cold  water,  to  which  alcohol  or  an  astrin- 
gent can  be  added.  It  may  even  be  better  to  use  simply  a  wet  cloth. 
In  that  condition  of  the  feet  known  as  bromidrosis,  or  stinking  feet, 
which  occurs  in  one  or  two  per  cent,  of  soldiers,  the  feet  sweat  pro- 
fusely and  give  off  a  fetid,  repulsive  odor.  The  skin  is  soft,  white 
and  easily  rubbed  off;  in  old  cases  it  may  become  congested  and 
eczematous.  The  usual  treatment  consists  in  painting  the  affected 


250 


MILITARY    HYGIENE. 


area  with  a  10%  solution  of  formalin,  taking  care  to  avoid  fissures 
and  abrasions.  Applications  are  generally  made  every  other  day, 
and  half  a  dozen  may  be  necessary  for  a  cure.  In  the  German  and 
French  armies,  a  10%  solution  of  chromic  acid  is  used,  and  repeated 
in  about  a  month. 


36. —  Lavatory  bowls.     Quartermaster  Corps  type. 


Each  company,  in  our  posts,  has  it  own  lavatory  which,  besides 
water-closets  and  urinals,  contains  wash-bowls,  shower-baths,  laun- 
dry tubs  and  sinks,  with  all  necessary  plumbing  fixtures.  (Fig. 
129.)  The  bowls  are  of  porcelain  and  supplied  with  hot  and  cold 
water.  (Fig.  36.)  There  should  be  at  least  one  for  each  five  men. 
They  may  be  thus  safely  used  in  common  if  kept  scrupulously  clean ; 
it  is  always  desirable,  however,  that  one  or  two  in  each  company  be 
reserved  for  men  suffering  from  contagious  affections.  Any  man 
who  so  desires  can  use  a  removable  individual  basin.  A  very  useful 
addition  to  the  lavatory  would  be  a  special  porcelain  or  zinc-lined 
trough  set  up  about  a  foot  above  the  ground  to  enable  the  men  to 
wash  their  feet  at  any  time. 

Soap  is  furnished  by  the  Quartermaster  Corps,  therefore  each 
man  should  be  required  to  have  and  use  his  own  piece.  An  excellent 
sanitary  and  economic  device  is  that  illustrated  in  Fig.  37,  in  which 
as  much  of  the  soap  as  necessary  is  grated  off  by  turning  a  crank, 
without  any  handling  of  the  cake.  Another  efficient  and  excellent 
device,  commonly  seen  in  hotels  and  other  public  places,  and  like- 
wise well  adapted  to  garrison  lavatories,  consists  in  the  use  of  liquid 
soap  from  small  receptacles  conveniently  placed  over  the  faucets. 


PERSONAL    HYGIENE.  251 

Drinking  cup. —  It  is  well  known  that  there  is  danger  in  drinking 
from  a  cup  or  glass  used  in  common  by  a  number  of  persons  with- 
out washing  or  disinfection,  danger  not  only  from  mouth  and  lip 
affections  but  also  from  various  infectious  germs  lurking  in  the 
saliva  of  carriers.  For  this  reason  the  common  cup  is  gradually 
disappearing  from  all  public  drinking  tanks  and  replaced  by  the 
bubble  fountain  which  enables  the  drinker  to  absorb  as  much  water 


FIG.  37. —  Soap  graoulator  in  use.     (Hygienic  Soap  Granulator  Co.) 

as  he  wishes  without  touching  the  fixtures  with  his  lips,  a  device  as 
economical  as  it  is  sanitary.  (Fig.  38.)  This  bubble  system  should 
be  installed  in  all  company  barracks,  as  well  as  in  standing  camps. 
In  its  absence,  the  soldier  must  use  his  individual  canteen  cup. 

BATHS. —  The  short  morning  bath  is  the  rule  for  everybody  who 
can  do  so.  The  soldier  can  seldom  enjoy  this  luxury,  nor  is  it 
necessary  for  cleanliness,  but  whenever  the  facilities  are  adequate 
he  should  be  required  to  bathe  the  entire  body  twice  a  week. 


252 


MILITARY    HYGIENE. 


A  bath  can  be  taken  at  various  temperatures.  It  is  cold  when 
ranging  from  40°  to  80°  F. ;  tepid,  from  80°  to  90°  ;  warm,  from 
90°  to  100°,  and  hot  when  above  100°.  The  water  has  also  different 
effects  according  to  its  temperature ;  thus  for  cleansing  purposes 
warm  water  should  be  used,  while  if  a  bracing,  tonic  effect  is  desired 
the  cold  bath  is  indicated.  The  benefit  of  both  cleansing  and  tonic 
effects  can  easily  be  obtained  by  following  the  warm  bath  by  a  cold 
sponging  or  shower,  or  a  plunge  into  cold  water. 


FIG.  38. —  Wash-hand  basin,  with  sanitary  bubbling  cup  at  the  right,  which 
flows  when  the  lever  below  is  pressed  down.  (American  Medical  Associa- 
tion Building.) 

That  the  cold  bath,  either  with  sponge,  in  tub  or  as  shower,  has  a 
decided  strengthening  effect  is  undoubted  and  therefore  should  be 
preferred  by  those  who  can  safely  take  it.  Not  only  is  it  a  general 
tonic,  but  it  also  hardens  the  peripheral  nerves  and  enables  them  to 
stand  exposure  with  greater  impunity,  so  that  the  cold  bather  seldom 
contracts  affections  of  the  nose,  throat  and  bronchial  tubes.  The 
shock  of  the  cold  bath  is  severe  and  cannot  be  borne  by  every  one ; 
it  is  positively  dangerous  for  men  with  cardiac  weakness  or 
degenerate  arteries.  The  test  of  its  usefulness  is  in  the  immediate 
after-effect  which  should  be  a  pleasurable  sensation  of  warmth  and 


PERSONAL    HYGIENE.  253 

increased  energy.  Should  the  bather,  on  the  contrary,  remain  chilly 
and  depressed,  he  should  abstain.  Cold  sponging  can  often  be  en- 
joyed by  delicate  persons  if  standing  with  feet  in  tepid  water. 

The  warm  bath  dilates  the  skin  capillaries  and  causes  free  per- 
spiration. It  has  a  general  soothing,  relaxing  and  sedative  effect, 
removing  the  soreness  of  tired  muscles  and  restoring  sleep  in 
insomnia. 

The  Turkish  bath  and  the  Russian  bath  are  taken  in  air  heated 
to  very  high  temperature  (120°  to  150°  F.),  dry  in  the  former, 
moist  in  the  latter ;  the  body  is  vigorously  rubbed  and  massaged,  then 
bathed  in  warm  water,  and  the  process  ends  with  a  cold  douche  or 
plunge,  and  thorough  drying.  Either  Turkish  or  Russian  bath  is 
somewhat  severe  and  should  be  carefully  tried  and  adjusted  to  the 
resistance  of  the  individual.  It  produces  a  perfect  cleansing  of  the 
surface,  abundant  elimination  of  waste  matter  through  the  profuse 
sweat,  and  relieves  internal  congestion.  It  is  especially  useful  to 
well-fed  men  of  sedentary  habits  and  therefore  seldom  needed  by 
soldiers. 

In  the  Army,  the  ordinary  tub  bath  is  inconvenient,  expensive  and 
insanitary,  and  should  seldom  be  seen  outside  of  post  hospitals.  It 
is  being  entirely  superseded  by  the  shower  bath  which  has  superior 
advantages  and  none  of  its  objections.  The  shower  bath  requires  a 
simpler,  more  easily  handled  apparatus,  and  consumes  much  less 
water  and  time.  With  it  the  transmission  of  disease,  not  unlikely 
in  a  tub,  is  made  impossible.  Moreover,  the  percussion  of  the  water 
upon  the  body  intensifies  the  tonic  effects  of  the  cold  water.  To 
get  the  full  benefit  of  this  percussion  the  nozzle  should  be  movable 
so  that  the  shower  may' be  projected  .at  any  angle.  Although  both 
warm  and  cold  water  are  provided,  the  men  should  gradually 
accustom  themselves  to  cold  water,  at  least  in  summer ;  but  warm 
water,  whenever  used,  must  always  be  followed  by  cold  water,  or 
as  cold  as  can  be  borne. 

While  bathing,  the  soldier  should  give  special  attention  to  the 
hairy  parts  of  the  body,  under  the  arms  and  about  the  genitals  and 
anus.  The  secretions  from  the  mucous  membrane  of  the  prepuce, 
particularly  in  men  with  long  foreskin,  soon  become  acrid  and 
irritating  and  should  be  regularly  washed  out.  In  such  cases  cir- 
cumcision is  often  advisable.  The  skin  around  the  anus,  as  well  as 


254  MILITARY    HYGIENE. 

the  anus  itself,  especially  in  case  of  hemorrhoids,  must  also  be 
thoroughly  cleansed. 

LAUNDERING. —  But  little  benefit  will  be  derived  from  washing 
the  body  if  the  linen  in  contact  with  it  and  constantly  absorbing  its 
secretions  is  not  frequently  changed.  Underclothing  wet  with 
perspiration  should  be  removed  and  dried  at  the  first  opportunity, 
before  being  worn  again.  No  man,  while  in  barracks,  should  be 
permitted  to  go  to  bed  in  the  underclothing  worn  during  the  day. 
Each  soldier  is  expected  to  provide  himself  with  two  or  more  sets 
of  pajamas  for  night  use. 

In  the  process  of  laundering,  the  linen  is  first  soaked  in  cold  or 
tepid  water,  then  washed  in  hot  or  boiling  water,  with  soap,  and 
finally  rinsed  out.  The  water  in  which  it  is  first  soaked  becomes 
charged  with  a  large  amount  of  organic  filth,  including  many  more 
germs,  according  to  Miguel,  than  are  contained  in  ordinary  sewage. 
This  polluted  water  is  therefore  particularly  dangerous  and  must 
be  disposed  of  in  such  manner  that  it  will  not  contaminate  the  soil 
nor  the  water-supply.  Clothing  which  is  boiled  is  thereby  dis- 
infected, that  is,  freed  from  all  ordinary  pathogenic  germs.  Boiling, 
however,  does  not  remove  the  ill-smelling  organic  dirt,  especially 
from  woolen  articles,  imparted  by  an  unclean  skin ;  this  must  be 
done  by  subsequent  rinsing  in  running  water  or  pure  water  fre- 
quently changed.  Properly  laundered  clothing,  when  tested  by  the 
nose,  should  have  no  other  than  a  clean,  sweet  smell. 

In  our  garrisons  there  is  no  general  regulation  governing  the 
washing  of  clothing.  A  few  laundry  tubs  are  provided  in  the 
lavatory  of  each  company  for  the  washing  of  such  articles  as  men 
may  find  necessary  to  do.  (Fig.  39.)  Each  soldier  is  expected  to 
have  his  own  laundry  done  as  best  he  can,  sometimes  at  much  in- 
convenience and  expense.  The  weekly  wash  thus  received  from 
various  outside  places  is  always  a  source  of  danger  since  it  may 
introduce  vermin  and  disease  germs  into  the  garrison.  It  is  there- 
fore highly  desirable,  as  a  sanitary  measure  as  well  as  for  the  con- 
venience of  the  men,  that  the  laundry  work  should  be  done  under 
official  supervision,  either  in  connection  with  post  exchanges  or  by 
means  of  properly  equipped  post  steam  laundries.  The  Act  making 
appropriation  for  the  support  of  the  Army  for  the  fiscal  year  1908, 
provides  "  for  the  construction,  operation  and  maintenance  of 


PERSONAL    HYGIENE. 


255 


laundries  at  military  posts  in  the  United  States  and  its  island  pos- 
sessions "  by  the  Quartermaster  Corps.  This  is  a  step  in  the  right 
direction  and  may  lead  to  a  complete  solution  of  this  vexed  problem. 


FIG.  39. —  Laundry  tubs.     Quartermaster  Corps  type. 

In  the  field,  the  cleanliness  of  clothing  must  not  be  neglected 
whatever  may  be  the  difficulties  in  the  way.  It  is  well  known  that 
some  of  our  most  dreaded  camp  diseases  result  from  the  con- 
veyance of  infectious  matter  from  man  to  man  by  the  skin  and 
clothing.  Therefore,  in  the  absence  of  special  provision  for  the 
purpose,  each  man  must  be  required  to  wash  and  boil  his  own  linen 
in  camp,  the  only  material  needed  being  water,  kettles  to  boil  it  in, 
and  soap.  Every  precaution,  however,  must  be  taken  to  secure  the 
proper  disposal  of  the  waste  water.  When  a  command  is  camped 
on  a  stream,  the  part  used  for  washing  should  be  the  lowest,  or  the 
farthest  removed  from  that  used  for  drinking  purposes. 

Care  of  bowels. —  An  important  feature  of  personal  hygiene  is 
that  which  relates  to  the  evacuation  of  the  bowels.  This  is  a  bodily 
function  which  must  be  attended  to  with  great  regularity,  that  is 
to  say,  daily  and  at  the  same  hour.  The  proper  time  for  most  men 
is  as  soon  as  convenient  or  possible  after  breakfast.  The  habit  of 
so  doing  is  very  easily  formed  so  that  the  desire  for  evacuation  is 
always  felt  at  the  right  moment  and  should  be  promptly  complied 
with.  Carelessness  in  heeding  this  call  of  nature  leads  to  bodily 


256  MILITARY    HYGIENE. 

discomfort,  digestive  disturbance,  constipation  and  the  various  ills 
which,  soon  or  late,  follow  in  its  train.  Such  neglect  is  a  distinct 
violation  of  one  of  the  primary  laws  of  nature.  The  young  soldier 
who  enjoys  the  advantages  of  regular  meals,  wholesome  food  and 
active  exercise,  should  never  have  occasion  to  take  cathartic 
medicines.  Any  sluggishness  of  bowels  should  be  overcome  by  a 
change  in  the  diet,  that  is,  less  meat  and  more  vegetables  and  fruits, 
massage  of  the  abdomen  and  more  exercise.  In  the  field,  where  the 
regular  habits  of  garrison  life  are  more  or  less  disturbed,  regularity 
in  bowel  evacuation  is  not  so  easily  maintained  and  requires  greater 
care,  but  is  also  quite  possible  and  fully  as  necessary. 

The  washing  of  the  hands  after  defecation  is  one  of  the  cardinal 
precepts  of  modern  hygiene.  Inasmuch  as  many  people  are  the 
unconscious  carriers  of  the  germs  of  various  infectious  diseases  in 
their  intestinal  canal,  the  contamination  of  their  fingers  with  those 
germs  in  using  toilet  paper,  or  otherwise,  is  always  possible, 
especially  by  men  of  unclean  habits.  Infection  may  thus  be  con- 
veyed to  the  squad-room  or  tent,  mess-room  and  kitchen.  There- 
fore, washing  of  the  hands  with  soap  and  water,  preferably  running 
water,  must  be  insisted  upon  and  necessary  conveniences  provided 
for  it.  (See  pages  495,  648,  742.) 

Skin  parasites,  see  page  112. 

Bedbugs,  lice  and  fleas,  see  pages  495,  144,  145. 

Swimming  and  swimming  pool,  see  pages  227,  228. 

Use  of  tobacco,  see  page  133. 

Addiction  to  narcotics,  see  page  138. 

Venereal  diseases,  see  page  122. 

Alcoholic  beverages,  see  page  414. 

Rules  in  eating  and  drinking,  see  page  406. 


CHAPTER  XXI. 
WATER. 

Water  is  necessary  to  all  animal  and  vegetable  life.  In  man  it 
forms  over  60  per  cent,  of  the  weight  of  the  body  and  is  indis- 
pensable to  the  ingestion  and  absorption  of  food  and  the  main- 
tenance of  the  normal  composition  of  all  our  tissues.  While  a 
mammal  can  use  up  almost  the  whole  of  the  body  fat  and  50  per 
cent,  of  its  protein  before  dying,  it  becomes  moribund  when  it  has 
lost  little  more  than  10  per  cent,  of  its  body  water  (L.  Hill}.  The 
water  of  the  body  being  constantly  excreted  through  the  skin, 
kidneys  and  intestines,  and  exhaled  through  the  lungs,  must  be 
constantly  replaced.  To  supply  this  loss,  from  70  to  100  ounces 
are  consumed  daily,  about  one-third  of  which  is  contained  in  our 
food. 

The  quantity  of  water  required  for  all  the  ordinary  needs  of  the 
body  may  be  liberally  computed  in  gallons  as  follows:  For  drink- 
ing, i ;  cooking,  2 ;  ablutions,  2 ;  laundry,  8 ;  water-closet,  6 ;  shower 
bath,  5 ;  total,  24  gallons.  Where  strict  economy  is  necessary,  one- 
half  this  quantity,  or  12  gallons,  may  be  made  to  answer  the  pur- 
pose. So  much  water,  however,  is  wanted  for  needs  not  directly 
connected  with  the  human  body,  namely,  for  animals,  street  water- 
ing, fountains,  factories,  etc.,  that  the  minimum  daily  supply  per 
head  in  our  cities  should  never  be  less  than  100  gallons.  In  fact, 
sanitary  engineers,  in  determining  the  capacity  of  waterworks, 
generally  base  their  calculations  upon  a  minimum  of  150  gallons  per 
capita.  Much  of  this  amount,  however,  is  recklessly  wasted.  In 
our  garrisons,  a  supply  of  from  50  to  75  gallons  is  amply  sufficient 
for  foot  troops,  but  twice  that  amount  must  be  provided  for  mounted 

troops. 

WATER  IN  NATURE. 

All  water  used  by  man  comes  from  the  condensation  of  the 
aqueous  vapor  of  the  atmosphere  in  the  form  of  rain,  snow,  fog 
and  dew.  The  larger  proportion  of  this  water  remains  on  the  sur- 
face as  brooks,  rivers,  ponds,  lakes  and  ocean.  The  rest  percolates 
through  the  porous  earth  until  stopped  by  impervious  strata,  at 
various  depths. 

257 


258  MILITARY    HYGIENE. 

Rain-water  is  the  purest  of  natural  waters.  It  would  be  more 
correct  to  say  that  it  is  the  least  polluted,  for  it  is  never  absolutely 
pure,  containing  many  of  the  constituents  and  impurities  of  the 
atmosphere.  The  air  which  it  dissolves  is  particularly  rich  in  oxygen 
(22  to  30  per  cent.)  and  in  carbon  dioxid  (2  to  10  per  cent.). 
Besides  coal,  sand  and  clay  dust,  and  various  other  mineral  sub- 
stances such  as  sodium  chloride,  calcareous  salts,  etc.,  in  almost 
infinitesimal  proportion,  rain-water  contains  also  as  constant  con- 
stituents, especially  in  cities,  ammonia  (mostly  as  carbonate)  and 
nitric  acid,  as  well  as  a  minute  quantity  of  organic  matter  and  a  few 
bacteria  (4  to  19  per  cubic  centimeter  according  to  Miguel). 

Rain-water  is  highly  aerated,  wholesome  and  palatable.  The 
absence  of  earthly  salts  makes  it  very  soft,  an  excellent  solvent  of 
soap,  and  admirably  suited  for  washing  and  cooking  purposes ;  but, 
for  drinking  water,  this  absence  of  salts  is  rather  a  defect  than  a 
quality. 

Cisterns  for  the  collection  of  rain-water  are  now  seldom  used 
at  our  military  posts,  but  there  are  times  and  places  when  and 
where  they  may  be  necessary.  Of  whatever  material  constructed, 


Movable  covering  stone 


Paving.  Level  of  ground. 


FIG.  40. —  A  filter  for  rain-water.     (Natter  and  Firth.) 


their  first  requirement  is  to  be  water-tight,  so  as  to  preclude  leakage 
inward  or  outward.  If  of  stone  or  brick,  they  should  be  thoroughly 
cemented ;  ordinary  mortar  will  not  do  for  the  lime  dissolves  in 
water  and  makes  it  hard.  If  of  iron,  an  unpleasant  taste  and  color 


WATER.  259 

are  imparted  to  the  water  unless  covered  with  a  protective  coating. 
Galvanized  iron,  unless  of  the  best  quality,  may  be  attacked  by  water 
charged  with  nitrates  and  its  component  zinc  dissolved,  a  metal  dis- 
agreeable to  the  taste  and  poisonous  when  continuously  absorbed. 
A  cistern  must  be  well  ventilated  but  kept  dark  to  prevent  the 
growth  of  animal  and  vegetable  life.  It  is  an  ideal  place  for  the 
breeding  of  mosquitoes  and  therefore  must  be  carefully  screened. 
The  first  portion  of  the  rainfall,  more  or  less  contaminated  by  the 
roof  surfaces,  should  be  rejected;  this  is  generally  done  by  some 
automatic  device.  Should  the  water  flow  over  the  sloping  surface 
of  adjoining  grounds,  it  may  be  advisable  to  pass  it  through  a  sand 
filter  before  letting  it  into  the  cistern  (Fig.  40). 

River-icater.  —  River-water  is  of  complex  and  variable  composi- 
tion, according  to  the  character  of  the  affluents  of  the  river,  the 
geological  nature  of  the  water-shed  feeding  it,  the  number  of  towns 
and  factories  located  on  its  shores  and  the  degree  of  cultivation  of 
the  adjoining  lands.  It  may  be  nearly  as  free  from  organic  matter 
as  rain-water  or  so  polluted  by  human  sewage  and  wastes  from 
factories  as  to  destroy  all  fish,  batracians  and  mollusks.  The  pollu- 
tion is  greatest  in  spring,  when  the  melting  snow  washes  into  it  the 
excrementitious  matters  scattered  on  the  shores  over  the  frozen 
ground.  In  countries  having  dry  and  rainy  seasons,  the  water  is 
most  polluted  at  the  onset  of  the  rainy  season,  generally  marked 
by  an  increase  of  intestinal  disorders.  It  always  contains  a  large 
amount  of  matter  in  suspension,  especially  in  our  western  and 
southern  rivers,  ranging  from  about  15  parts  per  1,000,000  in  the 
Hudson  River  at  Albany,  to  about  1,000  parts  in  the  Mississippi  at 
St.  Louis,  and  much  more  in  the  Rio  Grande  and  Colorado. 

River-water,  as  it  flows,  undergoes  a  very  important  spontaneous 
purification,  so  that  at  a  distance  of  from  20  to  50  miles  below  a 
large  city,  the  water  has  nearly  recovered  the  degree  of  organic 
purity  that  it  had  above  it.  Thus  the  river  Seine,  25  miles  below 
Paris,  is  hardly  any  more  contaminated  than  above  that  capital. 
The  Illinois  River,  some  24  miles  below  the  point  where  the  Chicago 
sewage  canal  empties  into  it,  shows  a  bacterial  content  but  slightly 
in  excess  of  that  of  the  local  tributary  streams  (Jordan).  This 
self-purification  is  the  result  of  the  following  agencies:  i.  Dilution 
by  tributary  streams,  especially  when  their  water  is  purer  or  of 
different  temperature  and  composition.  2.  Sedimentation,  the  natural 


260  MILITARY    HYGIENE. 

effect  of  gravitation,  whereby  all  organic  and  mineral  particles  tend 
to  fall  to  the  bottom,  much  more  rapidly,  however,  in  the  quiet  waters 
of  lakes  than  in  rivers;  micro-organisms  adhere  to  these  particles 
and  are  carried  down  with  them,  hence  the  comparative  freedom 
from  germs  of  the  water  of  our  western  rivers,  rich  in  suspended 
sand  and  clay,  after  it  has  been  allowed  to  settle.  3.  Solar  action, 
which  exerts  a  well-marked  oxidizing  and  destructive  effect  upon 
the  organic  matter  and  microbes  of  the  surface  and  down  to  a 
depth  of  a  few  feet,  according  to  the  intensity  of  light  and  trans- 
parency of  the  water.  4.  Biological  action,  probably  the  chief  and 
most  powerful  purifying  factor.  Numberless  animalcules,  as  well 
as  aquatic  cryptogams  (algae,  infusoria,  etc.),  feed  upon  organic 
matter,  but  their  action  is  slight  compared  to  that  of  the  usual 
nitrifying  bacteria  which  decompose  and  mineralize  animal  and 
vegetable  substances  with  great  energy,  as  will  be  explained  later. 
This  action  of  bacteria  requires  the  presence  of  an  abundant  supply 
of  oxygen  and  is  therefore  heightened  by  falls  and  rapids.  Along 
with  this  oxidation  and  decrease  of  organic  matter  there  is  a  cor- 
responding fall  in  the  number  of  organisms,  large  numbers  of  which 
are  thus  starved  out. 

Despite  this  self -purification,  there  is  in  the  streams  flowing 
through  well-settled  parts  of  all  countries,  a  residuum  of  contamina- 
tion which  makes  their  water  unsafe  for  drinking  without  under- 
going some  form  of  artificial  purification.  In  England,  the  con- 
clusion of  a  commission  appointed  to  make  a  special  study  of  the 
subject  was  that  there  is  no  river  wide  or  long  enough,  in  that 
country,  to  completely  purify  itself. 

Lake-water,  compared  to  river-water,  contains  less  matter  in 
solution  and  suspension,  nor  is  it  so  likely  to  become  polluted,  except 
at  certain  points  along  the  shore  where  sewage  or  waste  waters  are 
discharged ;  but  this  pollution  seldom  extends  very  far  in  large 
lakes  and  leaves  the  water  relatively  pure  half  a  mile  or  so  inward. 
In  the  most  contaminated  part  of  Lake  Michigan,  off  the  Calumet 
River,  there  is  a  zone  of  constant  pollution  extending  somewhat 
over  a  mile,  and  a  zone  of  occasional  pollution  extending  one  or  two 
miles  farther ;  beyond  the  4-mile  limit  the  water  is  remarkably  pure, 
giving  bacterial  counts  as  low  as  8  bacteria  to  the  c.  c. 

Spring-zvater  is  water  that  has  percolated  through  deep  strata 
and  which  therefore  is  thoroughly  filtered.  It  is  cool,  clear,  well 


WATER. 


26l 


aerated,  sparkling  and  palatable.  It  is  also  comparatively  free  from 
organic  matter  and  absolutely  so  from  pathogenic  germs,  but  likely 
to  be  rich  in  mineral  salts. 

WELLS. —  Ordinary  dug  wells  are  objectionable  but  sometimes 
inevitable.  The  deeper  they  are  the  more  completely  filtered  and 
purer  is  the  water  that  flows  into  them.  However,  provided  a  well 
traverses  at  least  one  impervious  stratum,  the  depth  is  less  important ; 
thus  a  well  that  penetrates  through  two  impervious  layers  of  clay 


FIG.  41. —  A  properly  constructed  well;  a,  water  stratum;  b,  layer  of  clay; 

c,  manhole. 

or  rock,  even  if  only  30  feet  deep,  possesses  all  the  advantages  of  a 
deep  well,  that  is  to  say,  regularity  of  output  and  constancy  of 
purity,  for  the  water  is  obliged  to  travel  a  long  and  circuitous  route. 
Shallow  wells  are  dangerous,  being  fed  by  surface  waters  and  liable 
to  be  polluted  by  many  impurities.  The  surface  area  drained  by  a 
well  should  be  kept  as  clean  as  possible,  especially  from  human 


262 


MILITARY    HYGIENE. 


excreta.  This  area  is  a  circle  whose  radius  is  about  twice  the  depth 
of  the  well,  therefore  being  200  feet  all  around  a  well  100  feet  deep. 
It  varies  according  to  the  nature  of  the  soil  and  the  daily  fall  of 
the  water  produced  by  pumping,  widening  in  direct  proportion  to 
this  fall. 

A  well,  to  be  above  suspicion,  must  comply  with  the  following 
requirements  (Fig.  41)  :  It  should  traverse  the  entire  aqueous 
stratum  (a)  and  extend  to  the  subjacent  impervious  clay  or  rock; 
it  should  be  lined  throughout,  or  at  least  above  the  water,  with  a 
well-constructed  masonry  wall  vaulted  at  top,  with  manhole  in  center 
(c)  and  thoroughly  cemented  inside,  but  with  enough  drain  holes 
in  the  aqueous  stratum.  The  pump,  instead  of  being  placed  directly 
over  it,  should  be  by  the  side  of  it.  If  there  be  especial  danger  of 
surface  contamination,  the  top  and  outside  of  the  wall,  to  half  its 
depth  or  more,  may  be  covered  with  a  layer  of  well-tamped  clay  (6). 
Sometimes  it  is  preferable  to  build  up  the  lining  wall  two  or  three 
feet  above  the  surface  of  the  ground;  in  such  case  the  well  must 
be  tightly  closed  at  top  and  the  ground  made  to  slope  away  from  it. 

In  locating  a  well  it  is  important 
to  ascertain  the  trend  of  the 
ground  water  and  make  sure  that 
it  is  not  likely  to  be  infected.  It 
should  be  above  and  sufficiently  far 
away  from  cesspools  and  latrines. 
Even  when  the  movement  of  the 
ground  water,  under  a  cesspool,  is 
away  from  the  well,  there  is  still 
danger  of  pollution  if  the  drainage 
from  the  cesspool,  as  it  spreads  in 
all  directions,  reaches  the  well  be- 
fore being  carried  off  by  the  ground 
water  (Fig.  43).  The  best  and  eas- 
iest test  to  ascertain  the  possibility 
of  such  infection  is  by  the  use  of  a 
strong  alkaline  solution  of  fluores- 
cine,  which,  if  thrown  into  the  cess- 
pool will,  in  case  of  leakage  into  the 


FIG.     42. —  Temporary     well     for 

camps,  with  portable  pump. 

(Munson.) 


well,  produce  a  characteristic  red  tint  in  the  suspected  water,  recog- 
nizable to  the  naked  eye  even  in  a  dilution  of  1/100,000,000  and,  by 


WATER. 


263 


its  strong  fluorescence,  in  a  still  much  higher  dilution.  Sodium  chlo- 
ride can  be  used  in  the  same  manner,  and  its  leakage  into  the  water 
ascertained  by  the  usual  silver  reagent,  having,  first,  ascertained  the 
normal  amount  of  chlorides  in  said  water.  For  the  same  purpose, 
the  culture  of  certain  germs  has  also  been  recommended,  such  as  the 
ordinary  beer  yeast  (Miguel)  or,  still  better,  the  bacillus  prodigiosus 
which  is  seldom  found  in  any  water,  harmless  and  readily  identified 
by  its  bright  red  color. 

Pipe  or  tubular  wells  are  greatly  superior  to  dug  wells,  in  all 
situations.  The  tube  prevents  contamination  from  surface  waters 
and  can  be  sunk  until  good  pure  water  is  reached,  at  least  through 
the  first  impermeable  layer  of  clay,  so  as  to  be  entirely  beyond  the 
possibility  of  infection.  Some  of  our  American  cities  are  being 
supplied  entirely  from  deep  tubular  wells  with  water  organically 
pure,  and  whenever  a  sufficient  amount  can  thus  be  obtained,  not 
containing  mineral  constituents  in  excess,  it  should  be  preferred  to 
any  that  requires  some  form  of  purification. 


-  -;  Grtfitnct,  WZeter'      -^-^ 


FIG.  43. —  Showing  how  a  well  may  be  polluted  from  cesspool  below  it  and 
protected  from  one  above  it. 

EXAMINATION   OF  WATER. 

External  Qualities.  —  Water  may  be  blue,  green,  gray,  yellow  or 
red  according  to  its  depth,  matter  in  suspension  and  reflected  sky, 
so  that  color  (unless  distinctly  muddy)  is  not  significant  of  its 
quality.  It  may  even  be  dark  reddish-brown  as  in  the  Dismal 
Swamp  and  many  streams,  the  effect  of  the  peaty  beds  over  which 
it  flows,  or  sometimes  the  result  of  a  combination  of  the  tannic  acid 
dissolved  from  aquatic  plants,  with  iron  oxids.  This  dark-colored 


264  MILITARY    HYGIENE. 

peaty  or  inky  water  used  to  be  preferred  by  ship  captains,  when, 
going  on  long  voyages,  on  account  of  its  keeping  qualities.  Several 
of  our  western  rivers  have  received  the  name  of  Colorado  (red) 
because  of  the  color  of  the  water  seen  by  reflected  light,  due  to  a 
large  amount  of  reddish  clay  in  suspension. 

Drinking  water  should  be  perfectly  clear  and  transparent,  but 
turbidity  caused  by  mineral  matters  in  suspension  is  quite  com- 
patible with  good  quality,  after  sedimentation.  A  bright,  sparkling 
water  may  be  assumed  to  contain  much  oxygen  and  carbon  dioxid 
in  solution,  but  does  not  contraindicate  the  presence  of  infectious 
organisms. 

But  little  reliance  can  be  placed  on  taste  in  determining  the  value 
of  drinking  water ;  it  may  be  very  palatable  and  yet  contain 
dangerous  bacterial  life;  while  the  taste  of  salt,  magnesia,  iron, 
sulphur,  etc.,  although  objectionable,  does  not  indicate  harmful  con- 
stituents. Iron  is  detectable  by  taste  when  present  to  the  extent 
of  1/5  grain  to  the  gallon,  and  salt  to  the  extent  of  75  grains.  The 
use  of  water  with  distinct  taste  of  sodium  and  magnesium  salts,  not 
uncommon  in  the  western  States,  is  often,  at  first,  accompanied  by 
slight  bowel  trouble  but,  as  a  rule,  the  system  soon  accommodates 
itself  to  it.  A  water  from  which  the  gases  have  been  more  or  less 
expelled  is  flat  and  unpalatable,  as,  for  instance,  boiled  water  not 
sufficiently  aerated,  but  quite  safe. 

Water  should  be  odorless ;  any  smell  is  suspicious,  especially  so  if 
of  animal  origin,  and  of  a  fecal  or  putrefactive  character.  Odors 
are  more  readily  detected  if  the  water  is  heated  and  shaken  in  a 
half-filled  quart  bottle.  Decaying  vegetable  matter  (mostly  algae 
and  diatoms)  often  produces  a  repulsive  taste  and  odor  in  the  water 
of  small,  badly-constructed  reservoirs,  rather  intensified  by  heating. 
They  are  mostly  noticed  in  the  fall  when  the  chilled  water  of  the 
surface  falls  to  the  bottom,  causing  vertical  currents  and  a  stirring 
up  of  the  strata.  Such  water,  although  decidedly  objectionable,  is 
probably  harmless. 

CHEMICAL   EXAMINATION. 

The  chemical  analysis  of  water,  that  is,  the  determination  of  its 
mineral  and  organic  constituents,  is  essential  to  estimate  its  qualities 
for  drinking  and  other  purposes ;  but  it  does  not  give  sufficient  in- 
formation; it  tells  nothing  of  the  presence  of  micro-organisms, 


WATER.  265 

especially  of  the  germs  of  infectious  diseases,  and  must  therefore 
be  supplemented  by  a  bacteriological  examination.  Both  are  neces- 
sary; they  mutually  help  and  complete  each  other. 

It  is  not  intended  here  to  describe  analytical  processes,  but  only 
to  indicate  the  mineral  and  organic  substances  usually  found  in 
water,  and  show  their  sanitary  significance,  that  is,  to  what  extent 
they  may  be  injurious  or  indicative  of  the  presence  of  infectious 
organisms. 

Total  Solids.  —  The  amount  of  total  solids  in  solution  conveys 
useful  information  but  is  not  of  much  sanitary  value.  Smart  sets 
the  safe  maximum  limit  at  300  parts  per  million,  and  Wanklyn  at 
575,  but  many  of  our  wafers,  particularly  those  of  our  western 
rivers,  greatly  exceed  those  figures  without  being  considered 
harmful. 

Hardness.  —  Water,  in  nature,  always  contains  mineral  salts  in 
variable  quantity,  and  we  may  assume  that  these  salts  supply  some 
of  the  needs  of  the  body.  Water  containing  them  to  a  moderate 
extent  is  therefore  much  better  than  distilled  water  for  drinking  pur- 
poses. The  proportion,  however,  should  be  small  and  the  water 
remain  "  soft."  Soft  water,  that  is,  water  free  from  an  excess  of 
earthy  salts,  is  best  for  all  purposes,  drinking,  cooking,  washing, 
steam  boilers  and  manufactures.  Water  is  said  to  be  "  hard " 
when  it  contains  so  much  earthy  salts  that  soap  does  not  readily 
form  a  lather  with  it.  The  hardness  is  "  temporary  "  or  "  perma- 
nent." Temporary  hardness  is  caused  by  calcium  and  magnesium 
carbonates  held  in  solution  by  the  free  carbon  dioxid  present  in  the 
water.  Boiling  expels  this  gas  and  precipitates  the  salts,  leaving  the 
water  soft;  the  same  result  is  obtained  by  the  addition  of  fresh  lime 
(Clark's  process)  which  combines  with  the  free  CO2  (one  gallon  of 
clear  lime-water  to  every  10  gallons  of  water).  Permanent  hard- 
ness is  caused  by  calcium  sulphate  and  other  salts  of  calcium  and 
magnesium,  not  carbonates.  Boiling  has  but  little  effect  upon  such 
water;  it  is  generally  treated  with  sodium  carbonate,  which  sets  up 
a  reaction  resulting  in  the  formation  of  neutral  and  inert  sodium 
sulphate  and  insoluble  carbonates  which  are  precipitated.  When 
soap  is  used  in  hard  water,  it  is  at  once  decomposed  with  formation 
of  insoluble  calcium  stearate,  and  does  not  begin  to  have  any  cleans- 
ing or  detergent  effect  until  all  the  calcium  has  thus  been  combined ; 
hence  the  enormous  waste  of  soap  when  used  with  such  water. 


266  MILITARY    HYGIENE. 

The  degree  of  hardness  of  water  is  readily  estimated  by  Clark's 
soap  test,  in  which  a  standardized  soap  solution  is  poured  into  a 
measured  quantity  of  water  until  a  persistent  lather  is  formed. 
Permanent  hardness  is  estimated  by  first  boiling  the  water  and 
getting  rid  of  the  carbonates. 

The  average  hardness  for  American  rivers,  expressed  in  so  many 
parts  of  calcium  carbonate  per  million  of  water,  is  50  for  soft,  and 
150  for  hard  water  (Leeds'  standard). 

The  metals  most  commonly  found  in  solution  in  water  are  lead, 
copper,  arsenic,  manganese  and  iron,  but  rarely  in  sufficient  quantity 
to  be  obnoxious,  except  iron  which,  when  exceeding  the  proportion 
of  i  part  per  million,  renders  water  unsuitable  for  washing  white 
goods,  bleaching  and  dyeing;  when  exceeding  3  parts  it  is  no  longer 
fit  for  drinking.  Iron  waters  are  usually  treated  simply  by  aeration 
which  causes  oxidation ;  the  oxid  is  removed  by  sand  filtration. 

ORGANIC  MATTER.  —  The  determination  of  organic  matter  in 
water  is  much  more  important  from  the  sanitary  point  of  view  than 
that  of  mineral  substances,  for  it  is  in  it  that  danger  lurks.  It  is 
estimated  by  the  combustion  process,  that  is,  by  evaporating  a  given 
quantity  of  water  in  a  platinum  dish  and,  after  weighing,  gradually 
raising  the  dish  and  its  contents  to  redness,  and  ascertaining  the 
"  loss  on  ignition."  It  is  important  to  observe  the  intensity  of  the 
charring  and  the  presence  or  absence  of  fumes :  the  latter,  if  pres- 
ent, may  indicate  the  character  or  source  of  the  organic  matter. 
Water  of  high  organic  purity  should  give  no  appreciable  blackening 
nor  odor.  According  to  Smart :  "  The  blackening  during  the  process 
is  of  more  interest  than  the  mere  loss  of  weight.  No  matter  how 
few  parts  are  lost,  if  the  lining  of  the  capsule  blackens  all  over  and 
the  carbon  is  afterward  dissipated  with  difficulty,  the  water  is  to  be 
viewed  as  suspicious.  What  are  called  "  peaty  "  waters  here  con- 
stitute the  exception." 

Another  method  of  estimating  organic  matter  is  by  determining 
the  amount  of  "  required  oxygen  "  to  oxidize  it.  It  consists  in  the 
addition  of  a  solution  of  potassium  permanganate  of  known  strength 
to  a  measured  amount  of  water  acidified  with  sulphuric  acid  and 
heated  to  the  boiling  point,  until  the  red  color  persists.  The  amount 
of  oxygen  required,  in  good  water,  should  not  exceed  two  or  three 
milligrams  to  a  million  milligrams  (i  kilo)  of  water. 

A  pretty  constant  relation  has  been  noticed  between  the  "  required 


WATER.  267 

oxygen  "  and  the  carbon  of  organic  matter,  the  latter  being  obtained 
by  multiplying  the  former  by  2.50  or  3.  Again,  the  proportion  of 
carbon  to  nitrogen  affords  evidence  as  to  the  origin  of  the  organic 
matter;  a  ratio  of  3  to  i,  or  less,  would  indicate  animal  matter,  while 
if  as  high  as  8  to  i,  matter  chiefly  or  entirely  of  vegetable  origin. 

The  percentage  of  dissolved  and  available  oxygen  is  of  great  value 
in  determining  the  quality  of  water,  for  the  higher  this  percentage 
the  greater  is  the  amount  of  organic  matter  that  can  be  disposed  of 
without  objectionable  effects.  It  is  estimated  that  to  maintain 
aquatic  animal  life  in  its  normal  state,  and  not  produce  nuisances, 
water  should  contain  at  least  70  per  cent,  of  dissolved  oxygen.  A 
fair  index  of  pollution  is  furnished  by  the  percentage  reduction  of 
dissolved  oxygen  when  the  water  is  kept  in  tightly  closed  bottles  and 
exposed  to  a  constant  temperature  for  a  definite  length  of  time. 

Carbon  is  a  constituent  of  every  living  tissue,  but,  from  the  sani- 
tary chemist's  point  of  view,  of  little  importance. 

It  is  from  nitrogenous  organic  matter  (nearly  always  from  animal 
sources)  that  we  obtain  our  most  useful  information ;  of  its  con- 
stituents, four  are  of  especial  significance,  namely :  chlorine,  am- 
monia, nitrites  and  nitrates. 

Chlorine  is  almost  invariably  found  in  water,  generally  as  sodium 
chloride  (common  salt)  washed  from  the  air  or  soil,  or  added  from 
cess-pools.  Salt,  of  itself,  is  harmless,  but,  when  in  excess,  shows 
probable  sewage  contamination.  Ordinary  sewage  contains  from 
1 10  to  160  parts  per  million  of  chlorine,  which  comes  almost  entirely 
from  the  urine,  the  solid  excrement  containing  but  a  minute  propor- 
tion. Before  estimating  the  significance  of  chlorine  it  is  necessary 
to  know  the  normal  amount  found  in  the  waters  of  the  region,  for 
this  is  very  much  influenced  by  the  proximity  of  the  sea  and  the 
existence  of  local  salt  strata.  Leeds'  standard  for  American  rivers 
is  from  3  to  10.  Frankland  places  the  permissible  limit  at  5. 

Ammonia  exists  in  water  as  free  ammonia  and  albuminoid  am- 
monia. Free  ammonia,  either  really  free  or  as  an  ammonium  salt, 
passes  over  unchanged  with  the  steam  when  the  water  is  distilled. 
Albuminoid  ammonia  does  not  exist  ready  formed,  but  is  a  product 
of  the  decomposition  of  organic  nitrogenous  substances  by  the  action 
of  potassium  permanganate.  Rain-water,  especially  when  collected 
near  large  cities,  often  contains  a  large  proportion  of  free  ammonia, 
while  river-water  seldom  shows  more  than  traces  of  it.  As  water 


~68  MILITARY    HYGIENE. 

filters  through  the  porous  earth,  its  ammonia  is  rapidly  converted 
into  nitrites  and  nitrates,  so  that  the  presence  of  this  gas  in  any 
considerable  quantity  in  shallow  wells  indicates  probable  recent 
contamination  with  animal  matter.  Growing  plants  have  a  marked 
influence  in  reducing  free  ammonia;  thus  a  lake  which  contains  as 
much  as  0.57  in  January  may  not  show  any  at  all  in  August 
(Drown).  A  high  proportion  of  ammonia,  without  animal  contami- 
nation, is  likely  to  be  found  in  waters  from  ferruginous  swampy 
regions,  owing  to  the  action  of  iron  oxids  upon  organic  matter. 
Likewise,  much  free  ammonia  may  exist  in  deep-well  waters  of 
excellent  quality,  due  to  the  reduction  of  nitrates  and  nitrites  by  sul- 
phide of  iron  or  other  agent,  such  nitrogen  salts  being  the  result  of 
oxidation  in  past  ages,  and  in  nowise  indicative  of  pollution  (C.  B. 
Fox}.  In  testing  for  ammonia,  the  rate  at  which  it  is  evolved, 
according  to  Smart,  is  as  important  as  the  total  amount :  "  Gradual 
evolution  of  albuminoid  ammonia  indicates  the  presence  of  organic 
matter,  whether  of  vegetable  or  animal  origin,  in  a  fresh  or  com- 
paratively fresh  condition,  while  rapid  evolution  indicates  that  the 
organic  matter  is  in  a  putrescent  or  decomposing  condition." 

According  to  Wanklyn,  water  containing  over  0.15  of  albuminoid 
ammonia  should  be  condemned ;  but  Mason  thinks  that  many  waters, 
especially  brown,  peaty  waters,  of  proved  wholesomeness,  may  far 
exceed  this  proportion.  The  following  maximum  limits  are  pro- 
posed by  Leeds : 

Free  ammonia  .01  to  .12  per  million. 

Albuminoid  ammonia       .10  to  .28  per  million. 

An  excess  of  free  ammonia  over  albuminoid  ammonia,  indicating  an 
active  process  of  decomposition,  is  always  a  suspicious  sign,  unless 
both  numbers  be  low. 

Nitrites  result  from  the  oxidation  of  the  ammonia  of  organic  mat- 
ter, the  second  step  in  the  process  of  nitrification,  or  may  likewise 
be  due  to  the  reduction  of  preexisting  nitrates.  Being  transition 
products,  their  presence  in  ground  or  surface  waters  is  usually  evi- 
dence of  active  fermentative  changes  and,  even  in  the  slightest  pro- 
portion, should  always  be  looked  upon  with  suspicion.  In  spring 
and  deep-well  water,  Frankland  has  shown  that  they  are  without 
significance,  being  generated  by  the  deoxidation  of  nitrates  "  brought 
about  either  by  the  action  of  reducing  mineral  substances,  such  as 
ferrous  oxid,  or  by  that  of  organic  matter  which  has  been  imbedded 


WATER.  269 

for  ages,  or,  if  dissolved  in  water,  subjected  to  exhaustive  filtration." 
The  absence  of  nitrites  proves  nothing;  it  may  be  due  to  lack  of 
available  oxygen  and  does  not  show  the  absence  of  dangerous  or- 
ganic matter.  Leeds'  standard  for  American  rivers  is  0.003.  Good 
water,  unless  from  deep  well,  should  not  exceed  o.oi. 

Nitrates  represent  the  completed  process  of  the  oxidation  of  nitro- 
genous organic  matter,  the  process  of  nitrification;  they  are  the 
ashes  of  organic  matter  and  therefore  simply  indicate  contamination 
at  some  previous  time.  This  contamination  is  more  likely  to  be  of 
animal  than  of  vegetable  origin,  not  only  because  of  the  greater 
quantity  of  nitrogen  present  in  animal  matter,  but  also  an  account 
of  its  more  ready  decomposition.  Nitrates  form  very  slowly  in 
rivers,  animal  matter  being  much  less  actively  oxidized  in  running 
water,  especially  if  deficient  in  dissolve^!  oxygen,  than  in  water 
percolating  through  the  soil,  and  are,  besides,  constantly  deoxidized 
by  the  addition  of  fresh  organic  pollution.  A  marked  departure, 
either  by  increase  or  decrease,  from  the  usual  proportion  of  nitrates 
in  any  water  may  be  taken  as  evidence  of  contamination.  There 
are  two  natural  sources  of  nitrogen  which  should  be  considered  in 
estimating  the  normal  proportion  of  nitrates  in  the  water  of  any 
region:  the  first  is  washed  from  the  atmosphere  as  nitric  acid  and 
amounts  from  0.15  to  0.40;  the  second  is  washed  from  soils  in 
which  certain  leguminous  plants  are  cultivated  (alfalfa,  clover,  cow- 
pea,  etc.)  and  where  it  is  stored  by  various  kinds  of  bacteria  which 
abstract  it  from  the  air.  (See  page  510.) 

Leeds'  standard  for  American  rivers  is  i.n  to  3.89.  Good  surface 
water  should  not  exceed  I  or  2  parts.  Spring  or  deep-well  water 
may  contain  a  much  larger  amount  without  significance,  having 
dissolved  it  while  filtering  through  various  strata,  or  from  old  beds 
of  nitrified  organic  matter  entirely  free  from  organisms.  When  the 
proportion  of  potassium  or  sodium  nitrate  exceeds  0.30  gram  per 
liter,  the  water  'acquires  well-marked  diuretic  properties. 

MICROSCOPIC  AND  BACTERIOLOGICAL  EXAMINATION. 
Water  contains  many  forms  of  low  cryptogamic  life,  such  as  fungi, 
algae,  desmids,  diatoms,  sponges,  infusoria,  etc.,  which  have  but  little 
effect  upon  its  sanitary  value,  except  in  occasionally  producing  very 
disagreeable  odors.  Some  branching  forms  of  minute  fungi  (clado- 
thri.v,  crenothri.r  and  beggiatoa)  multiply  rapidly  and  may  clog 


2/O  MILITARY    HYGIENE. 

pipes  and  drains,  or  sometimes  become  objectionable  on  account  of 
the  large  amount  of  iron  which  they  secrete ;  they  do  not  grow  in  the 
absence  of  sunlight.  Water  may  also  contain  the  eggs  of  intestinal 
parasites  such  as  ascaris,  oxyurus,  trichocephalus,  taenia,  ankylosto- 
mum,  etc.  It  ordinarily  abounds  with  many  forms  of  bacteria, 
nearly  all  of  which  are  saprophytic  and  probably  more  beneficial 
than  harmful.  Some  of  them,  however,  have  been  accused,  by  caus- 
ing putrid  fermentation,  of  increasing  the  virulence  of  pathogenic 
germs. 

According  to  Leon  Gerard  (of  Brussels),  a  properly  conducted 
microscopic  examination  may  afford  much  useful  information  con- 
cerning the  organic  impurities  of  water.  For  this  purpose,  the  water 
is  passed  successively  through  four  wire  screens,  each  with  meshes 
finer  than  the  preceding  (  from  500  to  5,300  meshes  per  square  centi- 
meter), the  last  screen  consisting  of  two  thicknesses  of  wire  cloth 
with  white  filtering  paper  between.  The  process  can  be  much  sim- 
plified and  expedited  by  the  use  of  large  centrifuges.  The  sediments 
on  each  screen  are  then  examined  with  magnifying  lens  and  micro- 
scope. Contamination  by  man  and  animals  is  indicated  by  four 
classes  of  substances:  I.  Fragments  of  textile  fabrics;  fibers  of 
wool,  cotton,  linen,  silk;  hairs  of  man  and  animals;  sections  of 
human  hair  cut  in  shaving,  in  the  shape  of  flat,  oval  or  roundish 
disks,  sometimes  extremely  thin  and  remarkably  well  preserved. 
2.  Grains  of  starch  (cereals,  potatoes,  etc.)  which  reveal  pollution 
from  kitchen  wastes.  3.  Debris  of  muscular  fragments,  easily 
recognized  by  their  structure  and  certain  microchemical  reactions; 
such  debris  indicating  almost  certainly  fecal  pollution.  4.  Eggs  of 
intestinal  parasites,  which  also  prove  contamination  by  the  fecal 
matter  of  man  or  animals. 

The  usual  and  principal  object  of  the  bacteriological  examination 
is  to  ascertain  whether  or  not  the  water  contains  pathogenic  organ- 
isms, or  the  organisms  which  are  usually  associated  with  them  and 
reveal  the  presence  of  contamination,  whether  from  sewage,  manure, 
or  other  source.  The  total  number  of  bacteria  contained  in  a  cubic 
centimeter  of  water  gives  us  doubtless  more  or  less  knowledge  of 
the  nature  and  extent  of  the  contamination;  it  is  mostly  valuable, 
however,  in  ascertaining  the  degree  of  efficiency  of  filtration ;  thus 
a  properly  constructed  and  well-conducted  filter  should  yield  water 
containing  less  than  100  bacteria  to  the  cubic  centimeter,  that  is  to 
say,  water  producing  less  than  that  number  of  colonies  when  sown 


WATER.  271 

on  nutrient  gelatine  and  kept  in  a  temperature  of  20°  C.  for  four 
days.  In  unfiltered  water,  the  number  varies  enormously;  but  in 
really  good  water  it  should  not  usually  exceed  1,000,  while  in  merely 
passable  water  it  ranges  from  1,000  to  10,000,  and  in  bad  water 
exceeds  10,000.  Spring-water  and  deep-well  water  are  most  free 
from  bacteria;  lake-water  comes  next  in  purity,  especially  at  some 
distance  from  the  shore,  while  river-water  is  the  worst.  The  Lake 
of  Geneva  was  found  to  contain  150,000  bacteria  to  the  c.  c.  near  the 
shore  and  only  38  in  the  middle  (Fol  et  Dunant}  ;  the  river  Seine, 
above  Paris,  from  46,340  in  December  to  13.710  in  August;  the 
Thames  (in  1886)  from  45,000  in  January  to  about  3,000  in  July. 
It  is  noticed  that,  in  temperate  regions,  the  number  falls  considerably 
in  summer  when  rains  are  few  and  shorter,  while  in  winter  the 
more  continuous  rains  and  many  small  streams  from  melting  snow 
carry  with  them  a  much  larger  amount  of  soil  pollution. 

The  degree  to  which  a  river  can  be  infected  by  the  sewage  of  a 
large  city  is  illustrated  by  the  Spree,  which  shows  only  8,951  bacteria 
above  Berlin  and  343,000  two  miles  below  it. 

The  most  usual  and  dangerous  pathogenic  organisms  present  in 
water  are  those  concerned  in  the  etiology  of  typhoid  fever  (bacillus 
typhosus),  cholera  (comma  bacillus  or  cholera  spirillum)  and  dys- 
entery (bacillus  dysenteric  of  Shiga,  and  others).  Unfortunately 
they  are  very  difficult  of  detection  in  water,  on  account  of  their 
comparative  rarity,  lack  of  resistance  and  shortness  of  life,  often 
disappearing  before  the  first  case  of  the  disease  is  diagnosed,  so  that 
their  presence  can  only  be  assumed  by  the  recognition  of  other  and 
more  common  intestinal  organisms,  more  or  less  harmless  to  man 
but  plainly  indicative  of  fecal  pollution.  These  witness  bacteria 
("bacterial  indicators"),  readily  found  and  recognized  in  water, 
are  always  present  in  the  intestinal  discharges  of  man  and  other 
mammals,  and,  therefore,  in  sewage  and  manure.  They  are: 

i.  Bacillus  coli  communis,  or  colon  bacillus.  The  best  indicator 
of  dangerous  contamination.  Common  everywhere  from  the  excre- 
ments of  man,  mammals  and  birds.  Under  favorable  conditions  it 
is  capable  of  multiplying  outside  the  body  so  that  it  may  become  a 
constituent  of  road  dust,  likely  to  be  blown  into  reservoirs  and  even 
cisterns,  but  this  mode  of  pollution  seldom  exceeds  a  few  bacteria 
to  the  cubic  centimeter.  There  is  no  evidence  that  the  true  type  of 
this  bacillus  is  ever  present  in  any  large  number  in  rivers  which  have 
not  been  exposed  to  fecal  contamination.  Under  ordinary  con- 


2/2  MILITARY    HYGIENE. 

ditions  it  does  not  multiply  in  water  supplies,  unless  they  contain 
fecal  matter.  Although  its  vitality  outside  the  body  is  not  great, 
it  is  more  resistant  that  the  bacillus  typ'hosus,  so  that,  if  absent,  it  is 
nearly  certain  that  the  latter  is  also  absent. 

As  it  is  not  possible  to  differentiate  the  human  colon  bacillus  from 
that  of  animals,  a  careful  study  should  be  made  of  all  the  factors 
involved  so  as  to  determine,  if  possible,  the  source  of  contamination ; 
for  instance,  whether  from  the  excrements  of  pasturing  animals  or 
from  latrines. 

The  colon  bacillus  includes  a  number  of  forms  differing  in  char- 
acters and  reactions  and  often  hard  to  separate.  The  typical  form 
is  the  only  one  that  has  much  significance.  It  is  identified  by  the 
following  characteristics :  fermentation  of  glucose  or  lactose  broth 
with  rapid  gas  production,  most  or  the  whole  of  it  being  evolved  in 
twenty- four  hours,  the  total  amount  approximating  about  50  per 
cent,  and  consisting  of  H  and  CO2  in  the  proportion  of  2  to  i ; 
liquid  in  bulb  of  fermentation  tube  strongly  acid;  a  distinct  indol 
reaction ;  coagulation  of  milk  in  i  to  3  days ;  growth  on  gelatine  in 
the  form  of  non-liquefying,  opaque,  whitish  expansions  with  irregu- 
lar margin. 

2.  Bacillus  lactis  aerogenes,  closely  allied  to  the  colon  bacillus 
and,  like  it,  almost  constantly  present  in  the  human  intestine.     Also 
nearly  always  found  in  milk. 

3.  Streptococci,  under  several  forms,  are  abundant  in  human  and 
animal  excreta  and  therefore  in  sewage.     They  are  naturally  para- 
sitic, delicate  germs,  unable  to  multiply  and  rapidly  dying  outside 
the  animal  body,   although   some  persistent   forms  are  met  with. 
They  seldom  live  more  than  a  week  or  two  in  water ;  their  detection 
in  any  quantity,  therefore,  shows  recent  fecal  pollution,  and  therein 
lies  their  chief  value  as  bacterial  indicator. 

4.  Bacillus  enteritidis  sporogenes  (Klein),  possibly  identical  with 
B.  aerogenes  capsulatus  of  Welch,  is  also  abundant  in  human  and 
animal  excreta,  but  its   usefulness  as  an  indicator  is  very  much 
limited  by  the  fact  that  the  spores  only  can  be  used  for  its  detection, 
not  the  bacillus  itself.     As  these  spores  are  highly  resistant  and  may 
persist  for  long  periods,  their  presence  simply  indicates  pollution  at 
some  indefinite  time  in  the  past  (perhaps  weeks  or  months  before) 
and  which  may  have  long  ceased  to  exist.     Therefore,  of  them- 
selves, they  are  without  signficance,  but  when  found  with  the  colon 
bacillus  add  confirmation  to  the  evidence  yielded  by  that  organism. 


CHAPTER    XXII. 
WATER    PURIFICATION. 

Water,  to  be  pure,  or  at  least  potable  and  safe,  must  be  ridden  of 
its  obnoxious  constituents,  especially  its  organic  matter  and  micro- 
organisms. 

The  three  general  methods  of  purification  are  by  heat,  chemical 
means  and  filtration. 

For  an  army  in  the  field,  the  ideal  method  of  purification  is  one 
that  can  be  carried  out  in  all  situations,  with  a  small,  simple,  trans- 
portable outfit  yielding  plenty  of  good,  cool,  palatable  water  within 
a  short  time.  Thus  a  regiment  of  1,800  men  should  have  at  least 
400  gallons  of  purified  water  within  two  hours  after  going  into 
camp.  However  strict  the  discipline,  it  will  always  be  very  difficult 
to  prevent  men,  when  impelled  by  thirst,  to  drink  from  condemned 
sources  if  good  water  is  not  promptly  available. 

HEAT. 

Heat  is  the  most  certain  and  effective  of  purifying  agents  and  the 
surest  means  of  obtaining  an  absolutely  sterile  water.  Boiling 
destroys  all  pathogenic  germs ;  it  also  removes  the  temporary  hard- 
ness of  water  by  precipitating  the  carbonates.  It  does  not  decom- 
pose organic  matter,  nor  destroy  its  odor  or  color,  but  renders  it  less 
putrescible.  An  objection  to  boiling  drinking  water  is  that  its  gases 
are  driven  out,  leaving  it  flat  and  unpalatable.  But  boiling  is  not 
necessary  for  the  practical  sterilization  of  water.  A  temperature  of 
165°  F.,  maintained  for  ten  minutes,  is  sufficient  for  the  destruction 
of  all  ordinary  pathogenic  bacteria ;  thus  less  fuel  and  time  are 
required;  less  gas  is  lost  and  the  more  rapidly  is  the  water  cooled 
down.  Water  purified  by  boiling  should  always  be  thoroughly 
aerated  after  cooling,  by  dipping  and  pouring  from  a  height,  decant- 
ing from  one  kettle  to  another  or  blowing  air  directly  into  it. 

In  the  field,  the  camp  fire  can  generally  be  resorted  to,  in  the 
absence  of  special  apparatus,  provided  suitable  kettles  are  available. 
The  water  should  be  sterilized  in  the  evening,  properly  aerated  and 
the  canteens  filled  directly  afterward  so  that  it  may  be  quite  cold  in 
the  morning.  This  primitive  method  of  sterilization,  although  often 
necessary,  is  seldom  satisfactory. 

273 


MILITARY    HYGIENE. 


THE   FORBES   STERILIZER. 

-rilizer  (Fig.  44)  was  officially  adopted  in  the  Army  after 
ative   tests  by   a   special  board   in    1898.     Fig.  45,   which   is 
.ely  diagrammatic,  illustrates  the  principle  of  its  operation. 


y 


FIG.  44. —  Forbes  sterilizer  ready  for  operation. 


WATER    PURIFICATION. 


2/5 


Raw  water  enters  at  i  and  passing  through  the  open  valve  7  flows 
down  through  the  tube  2  and  enters  the  lower  end  of  the  raw  water 
compartment  3  of  the  "  heat  exchange."  Rising  in  the  compart- 
ment 3,  the  water,  which  is  shown  by  light  shading,  fills  the  com- 
partment and  enters  the  float-box  4.  Passing  from  the  float-box  4, 
the  water  enters  and  fills  the  heater  5  up  to  the  level  X.  The  water 


19 


FIG.  45. —  Schematic  diagram  of  the  Forbes  sterilizer. 

in  the  float-box  4  must  also  be  at  the  same  level  X  and  at  this  point 
the  water  lifts  the  float  6  and  closes  the  valve  7,  thereby  preventing 
more  water  entering  the  apparatus  at  I. 

Should  the  float  or  valve  stick  or  fail  to  work  through  any  cause, 
the  water  will  continue  to  rise  in  the  float-box  4  and  likewise  in  the 


2/6  MILITARY    HYGIENE. 

heater  5  until  it  reaches  the  level  Y,  where  it  will  overflow  at  8  and 
pass  through  the  pipe  9  to  waste.  Higher  than  this  level  Y  the  water 
cannot  go. 

Heat,  in  the  shape  of  flame  10,  is  applied  under  the  heater  5, 
thereby  causing  the  water  in  5  to  boil,  and  in  boiling  it  will  rise  in  the 
tube  and  overflow  at  the  top  into  the  catch-all  n.  From  the  catch- 
all  1 1  the  hot  sterile  water,  represented  by  dark  shading,  flows  down 
through  12  into  the  sterile  \vater  compartment  13  of  the  "  heat  ex- 
change." The  pipe  14  conveys  the  sterile  water  up  to  the  discharge 
15.  This  outlet  15  is  brought  to  the  top  of  the  "  heat  exchange  "  to 
insure  the  sterile  water  compartment  13  always  being  full  of  water. 
While  passing  down  through  the  sterile  water  compartment  13,  the 
heat  of  the  water  is  absorbed  by  the  cold  water  rising  through  the 
raw  water  compartment  3,  and  the  transfer  of  the  heat  from  the 
hot  to  the  cold  water  takes  place  through  the  thin  metal  diaphragm 
16;  so  that  the  water  leaves  the  apparatus  cold,  having  given  up  its 
heat  to  the  cold  water  entering  while,  on  the  other  hand,  the  cold 
water  entering  the  apparatus,  having  absorbed  the  heat  of  the  hot 
water  leaving  the  apparatus,  enters  the  float-box  4  and  heater  5  very 
hot  and  nearly  at  the  boiling  point.  Only  a  small  amount  of  heat  is, 
therefore,  necessary  to  keep  the  sterilizer  in  continuous  operation. 

The  heating  apparatus  consists  of  the  oil  reservoir,  air  pump  and 
the  burner  proper.  This  is  the  most  important  feature  of  the  ster- 
ilizer and  its  construction  and  management  must  be  thoroughly 
understood  and  mastered  by  the  operator  if  good  results  are  desired. 

The  Forbes  sterilizer,  packed  in  its  field  case  of  galvanized  steel, 
is  37  inches  high  and  nl/2  inches  in  diameter,  and  weighs  96  pounds. 
It  burns  one  quart  of  oil  in  three  hours,  and  averages  an  output  of 
15  to  20  gallons  of  sterile  water  an  hour. 

As  in  every  other  form  of  sterilizer,  the  water  remaining  in  the 
apparatus,  when  not  in  use,  becomes  rapidly  contaminated  with  the 
ordinary  saprophytic  bacteria,  and  on  that  account  it  is  advisable, 
when  again  started,  to  reject  the  output  of  the  first  half  hour. 

This  sterilizer,  when  properly  operated,  is  entirely  reliable  and  has 
rendered  excellent  service  in  many  of  our  camps  and  garrisons.  Its 
advantages  may  be  stated  as  follows : 

1.  The  water  is  not  deprived  of  its  natural  gases. 

2.  All  living  micro-organisms  are  destroyed,  except  a  few  harm- 
less spore-bearing  bacteria. 


WATER    PURIFICATION 


277 


3.  It  may  be  kept  in  action  for  24  hours  without  renewing  the 
supply  of  oil  in  the  reservoir. 

4.  The  water  flows  out  of  the  apparatus  oniy  4^/2°  F.  warmer 
than  when  it  entered  it. 

5.  It  is  easily  taken  apart,  cleansed  and  put  together  again. 

6.  It  is  durable,  not  liable  to  breakage  and  very  easily  transported. 
Besides  the  usual  form  above  described,  for  burning  mineral  oil, 

there  is  another  with  fire-box  attachment  for  burning  wood  or  coal. 


FIG.  46. —  Barrel  accessory  set  up,   ready  for  operation  in  connection  with 

the  Forbes  sterilizer. 

There  is  also  a  "  barrel  accessory  "  (Fig.  46)  consisting  of  two  bar- 
rels, a  large  one  for  raw  water,  elevated  on  a  steel  stand,  supplying 
the  sterilizer  through  a  rubber  tube,  and  a  smaller  one  into  which 
the  sterile  water  is  discharged. 

WHEELED  STERILIZERS.  —  For  field  purposes,  however,  a  sterilizer 
to  be  entirely  satisfactory  should  be  mounted  on  wheels  and  able  to 


2/8 


MILITARY    HYGIENE. 


follow  a  moving  command,  consume  either  wood  or  coal,  yield  a 
sufficient  daily  output  for  at  least  a  regiment  and  always  have  a 
reserve  of  available  cool  water  in  its  tank.  Such  are  the  German 
Henneberg  Trinkwasser  (Fig.  47)  and  the  French  Vaillard-Des- 
maroux  outfits,  in  which  the  water  is  raised,  under  pressure,  to  a 
temperature  of  240°  F.  without  boiling,  so  that  it  is  rendered  abso- 
lutely sterile  without  the  loss  of  any  air.  These  types  are  open  to 


FIG.  47. —  The  German  Henneberg  Trinkwasser  wagon. 

the  objection  that  the  absolute  sterility  which  they  produce  is  not 
required,  therefore  that  they  consume  more  fuel  than  is  necessary 
and  deliver  a  water  relatively  hot. 

The  Forbes  Co.  also  constructs  several  kinds  of  sterilizers  on 
wheels,  all  on  the  same  heat  exchange  principle,  and  consisting  of 
boiler,  pumps,  filter,  sterilizer  and  storage  tank.  The  "Army 
Wagon  Sterilizer,"  mounted  on  the  regulation  Army-wagon  wheels, 
filters  and  sterilizes  300  gallons  of  water  per  hour,  and  14  men 
draw  their  supply  at  the  same  time  from  its  i5o-gallon  storage 
tank.  The  "  Forbes  Transportable  Water  Sterilizer  "  (Fig.  48)  is 
a  more  recent  type,  mounted  on  the  British  Army  limber.  It  is 


WATER    PURIFICATION. 


279 


lighter  and  more  mobile.  Its  capacity  is  400  gallons  per  hour  and 
consumes  approximately  one  gallon  per  hour  of  gasoline.  Its  col- 
lapsible canvas  storage  tank  has  a  capacity  of  2000  gallons. 

GRIFFITH  STERILIZER.  —  In  England,  the  Griffith  sterilizer  is 
highly  spoken  of  and,  apparently,  well  adapted  to  military  purposes. 
It  consists  essentially  of  a  heater  and  a  cooler.  The  heat  is  obtained 
from  a  lamp  burning  coal  oil  under  pressure.  As  soon  as  the  water 
reaches  the  temperature  of  180°  F.,  which  is  more  than  sufficient  to 
destroy  all  disease-bearing  organisms,  a  valve  opens  automatically, 
by  expansion,  and  allows  it  to  flow  into  the  cooler.  A  larger  type, 
mounted  on  wheels,  gives  350  gallons  of  water  an  hour  and  has  a 


FIG.  48. —  The  Forbes  Transportable  Water  Sterilizer. 

storage  tank  for  50  gallons.    It  consumes  I  gallon  of  oil  to  sterilize 
480  gallons  of  water. 

Disadvantages  of  Sterilizers.  —  Several  objections  may  be  raised 
against  heat  sterilizers.  They  are  costly  and  heavy.  The  fuel, 
whether  it  be  oil,  coal  or  wood,  will  often  be  difficult  to  procure  and 
transport  in  sufficient  quantity.  They  can  seldom  follow  troops  to 
the  front,  and  are  best  adapted  to  more  or  less  stationary  camps. 
All  sterilizers,  particularly  the  large  types,  are  more  or  less  com- 


280  MILITARY    HYGIENE. 

plicated  and  require  careful  and  intelligent  management.  Their 
efficiency  is  also  materially  impaired  by  water  containing  much 
carbonate  of  lime  which  soon  incrusts  the  partitions  or  tubes  of 
the  heat  exchange,  as  well  as  the  boiler,  and  lessens  the,  output. 

DISTILLED  WATER.  —  Distilled  water  is  necessarily  pure  and  ster- 
ile, but  the  absence  of  mineral  waters  and  scarcity  of  gases  in  solu- 
tion render  it  somewhat  insipid  and  less  fitted  to  the  needs  of  the 
body  than  good  natural  water.  Through  osmosis  it  absorbs  mineral 
substances  from  the  tissues  without  contributing  any  solids  in  re- 
turn, a  drain  to  which  has  been  attributed  decay  of  the  teeth  and 
various  other  symptoms  of  a  lack  of  salts  in  the  system.  Distilled 
water  has  a  noticeable  solvent  action  on  metals  and  care  must  be 
taken  that  it  does  not  come  in  prolonged  contact  with  lead,  zinc  or 
copper.  It  is  also  liable  to  be  contaminated  with  objectionable 
gaseous  substances  if  distilled  from  foul  water,  salt  or  fresh. 

COLD.  —  The  purifying  action  of  cold  also  deserves  to  be  noted. 
Water  in  freezing  forces  out,  into  the  subjacent  layer,  most  of  its 
matters  in  solution  but  only  a  part  of  those  held  in  suspension,  retain- 
ing most  of  its  organic  matter  and  bacteria,  especially  when  much 
air  is  imprisoned  as  in  snow  or  porous  ice.  Therefore,  clear  ice  is 
purer  than  snowy  ice,  and  top  ice  (if  clear)  than  deep  ice.  The 
first  effect  of  congelation,  according  to  C.  Frankel,  is  the  death  of 
the  greater  part  of  the  micro-organisms;  four-fifths  disappear  in 
two  days  and  nine-tenths  in  five  days.  The  pathogenic  bacteria,  how- 
ever, are  among  those  most  resistant  to  cold ;  when  subjected  to  a 
freezing  temperature,  the  cholera  bacillus  succumbs  in  seven  days, 
but  the  anthrax  bacillus  may  persist  for  weeks  and  the  typhoid 
bacillus  for  several  months.  It  is  also  of  common  notoriety  that 
the  larvae  of  mosquitoes  may  remain  in  ice  all  winter  in  a  quiescent 
state  and,  in  the  following  spring,  develop  into  full-fledged  insects. 
We  may  then  conclude  that  ice  is  better  than  the  raw  water  beneath, 
especially  if  from  a  deep,  calm  pond  or  lake,  but  that  it  is  not 
always  safe,  that  it  may  contain  thousand  of  microbes  and  has  been 
the  means  of  transmission  of  typhoid  fever.  Therefore,  unless  it 
is  known  to  be  reasonably  pure,  it  should  not  be  used  in  water  nor 
placed  in  contact  with  articles  of  food.  Artificial  ice,  if  made  from 
distilled  water,  as  it  always  should  be,  is  entirely  above  suspicion 
and  should  always  be  preferred. 

Snow  takes  up  foreign  substances  from  the  air  as  it  falls,  absorbs 


WATER    PURIFICATION.  28 1 

them  from  the  soil  on  which  it  lies,  and  is  constantly  exposed  to 
pollution.  After  a  heavy  snowfall  the  top  layer  is  more  or  less 
sterile;  but,  as  a  rule,  snow  water  needs  purification. 

CHEMICAL    MEANS. 

Chemical  agents  purify  water  by  the  oxidation  of  its  organic 
matter  and  microbes,  or  by  the  precipitation  of  its  matters  in  sus- 
pension. The  use  of  these  agents  is  attended  with  some  difficulties 
and  seldom  practicable  in  the  field.  The  proportion  of  chemicals 
must  be  adjusted  to  the  character  and  impurities  of  the  water, 
rendering  a  careful  and  variable  dosage  necessary.  They  often 
require  a  partial  removal  of  organic  matter  before  their  use,  and  as 
they  may  produce  precipitates  or  turbidity,  clarification  afterward. 
Moreover,  foreign  substances  are  introduced  into  the  water,  often 
imparting  an  unpleasant  taste  to  it,  and  the  effect  of  which  upon 
the  body  economy  has  to  be  considered. 

Ozone.  —  One  of  the  best  methods  of  purification,  so  far  devised, 
is  undoubtedly  that  by  ozone,  based  upon  the  powerful  oxidizing 
effect  of  ozonized  air  upon  organic  matter  and  micro-organisms. 
First  introduced  by  Ohlmuller  and  recently  perfected  by  Siemens 
and  Halske,  this  method  has  already  given  very  remarkable  results, 
under  favorable  conditions,  absolutely  eliminating  both  organic 
matter  and  bacteria  from  the  water.  The  ozone  is  generated  by  a 
special  apparatus  and,  after  being  mixed  with  a  current  of  dry  air, 
forced  up  a  cylinder  containing  gravel  and  down  which  the  raw 
water  percolates.  It  imparts  no  unpalatable  or  harmful  element  to 
the  water  and  in  no  way  modifies  its  chemical  and  physical  prop- 
erties, dissolved  salts  or  gases.  Its  action  is  very  rapid  and,  being 
eminently  unstable,  leaves  no  trace  a  few  moments  after  its  mixture 
with  the  water.  It  first  oxidizes  the  organic  matter,  and  afterward 
the  more  resistant  bacteria ;  the  amount  therefore  must  vary  with 
the  proportion  of  organic  matter  and  demands  a  nice  adjustment 
at  the  hands  of  a  skilled  operator.  Turbid  water  generally  requires 
a  preliminary  filtration. 

The  entire  sterilizing  outfit  has  been  mounted  on  wheels  with  the 
object  of  making  it  available  for  troops  in  the  field,  but  it  is  not 
well  adapted  to  that  purpose  on  account  of  its  complexity,  the 
expert  manipulation  required  and  the  variable  composition  of  the 
waters  to  be  purified. 


282  MILITARY    HYGIENE. 

With  filtered  water,  i  or  2  grams  of  ozone  to  the  cubic  meter  of 
water  is  sufficient,  but,  in  the  field,  dealing  with  variable  waters, 
larger  doses  are  needed,  averaging  about  15  grams  (3  cubic  meters 
of  ozonized  air)  per  cubic  meter  of  water. 

Ozone,  as  water  sterilizer,  on  account  of  its  cost  and  the  difficulty 
of  accurate  dosage,  is  still  seldom  used. 

Ultra-violet  rays.  —  Water  sterilization  by  means  of  these  rays  has 
been  shown  to  be  possible  and  practical.  Mercury-vapor  lamps,  with 
quartz  walls,  are  almost  an  ideal  source  of  ultra-violet  rays,  emitting 
the  intermediate  rays  (from  3000  to  2200  Angstrom  units)  which 
are  most  efficient  for  sterilization,,  being  highly  bactericidal  and 
sufficiently  penetrating.  These  lamps  act  best  when  immersed  in 
the  water  to  be  purified,  their  radius  of  action  being  at  least  a  foot. 
Sterilization  is  complete  in  less  than  a  minute  without  any  alteration 
of  the  physical  and  chemical  properties  of  the  water.  Experiments 
in  Manila  have  shown  that  typhoid  bacilli  as  well  as  amoebae  (motile 
or  encysted)  are  killed  in  5  seconds.  These  rays  are  applicable  only 
to  clear  or  clarified  water,  not  heavily  polluted.  They  are  useless 
for  liquids  containing  colloid  substances  such  as  milk,  broth,  wine, 
etc. 

This  method  of  purification  promises  to  become  well  adapted  to 
the  requirements  of  permanent  camps  by  the  simplicity  of  the 
apparatus  and  cheapness  of  its  operation. 

The  Nogier  ultra-violet  mercury  lamp  has  been  successfully  used 
in  France.  It  is  claimed  to  yield  from  400  to  500  liters  of  absolutely 
sterile  water  per  hour.  It  is  from  6  to  12  inches  long  and  only 
requires  a  continued  current  of  30  to  35  volts  and  5  to  7  amperes. 

The  other  chemicals  recommended  at  various  times  for  the  puri- 
fication of  water  include  bromine,  iodine,  chlorine,  potassium 
permanganate,  sodium  bisulphate  and  copper. 

Bromine,  according  to  the  Shumbnrg  method,  is  used  in  a  solution 
of  potassium  bromide  (20  grms.  each  of  bromine  and  potassium 
bromide  in  100  cubic  centimeters  of  water).  About  two  cubic  centi- 
meters are  sufficient  for  one  quart  of  ordinary  raw  water ;  at  the 
end  of  15  or  20  minutes  the  excess  of  bromine  is  neutralized  with 
ammonia  or  sodium  hyposulphite.  A  large  proportion  of  microbes 
are  destroyed  but  many  escape ;  furthermore,  the  transportation  and 
handling  of  bromine  and  other  chemicals  in  solution  are  inconvenient 
and  often  impracticable  in  the  field. 


WATER    PURIFICATION.  283 

Iodine,  as  recommended  by  Vaillard,  is  less  objectionable  as  only 
tablets  are  used.  Three  kinds  are  required:  No.  i  (blue),  contain- 
ing potassium  iodide  and  sodium  iodate;  No.  2  (red),  of  tartaric 
acid;  No.  3  (white),  of  sodium  hyposulphite.  If  one  blue  and  one 
red  tablets  be  crushed  and  dissolved  in  a  little  water,  a  brown  fluid 
containing  0.06  grain  of  nascent  iodine  results;  this,  if  added  to  a 
liter  of  water,  will  destroy  its  micro-organisms  in  ten  minutes. 
Tablet  No.  3  may  then  be  added  to  neutralize  the  excess.  This  is  a 
neat  and  efficient  process,  somewhat  complex  for  general  use  but 
well  adapted  to  the  needs  of  officers  and  small  detachments. 
Nesfield  recommends  that  the  iodine  be  increased  to  l/2  grain  per 
gallon  for  the  best  results. 

Chloride  of  lime  (chlorinated  lime  or  bleaching  powder)  is  one 
of  the  most  effective  agents  in  water  purification  and  now  exten- 
sively employed  for  this  purpose  in  connection  with  filtration  or 
(where  the  water  is  reasonably  clear)  independently  of  it.  It  con- 
sists of  about  equal  amounts  of  calcium  chloride  and  calcium 
hypochlorite,  the  proportion  of  available  chlorin  averaging  about  35 
per  cent.  When  added  to  water,  the  calcium  chloride  remains  inert ; 
the  hypochlorite,  acted  upon  by  the  CO2  in  the  water,  splits  into 
calcium  carbonate  and  hypochlorous  acid.  This  acid  which  is  ex- 
ceedingly unstable  breaks  up,  its  chlorin  combining  with  the 
hydrogen  of  the  water  to  form  hydrochloric  acid  while  its  oxygen 
is  liberated.  The  hydrochloric  acid  decomposes  the  carbonates  of  the 
water  and  becomes  reduced  to  calcium  chloride.  It  is  to  the  oxygen 
thus  liberated  in  an  atomic  or  nascent  state  that  the  strong  steriliz- 
ing action  of  hypochlorites  is  due.  As  ordinarily  used  their  effects 
are:  destruction  of  most  non-spore  bearing  bacteria,  oxidation  of 
organic  matter  proportional  to  the  amount  of  chemical  employed, 
partial  removal  of  color  as  well  as  more  or  less  complete  removal 
of  any  swampy  taste  and  odor.  On  the  other  hand,  there  is  a  slight 
increase  in  total  hardness  and  total  solids.  Unless  used  in  excessive 
doses  the  changes  in  physical  and  chemical  characteristics  of  the 
water  are  barely  noticeable ;  free  chlorin,  as  a  rule,  cannot  be  de- 
tected, and  any  imparted  taste  or  odor  is  quickly  dissipated  by 
agitation  of  the  water. 

Sodium  hypochlorite  (chlorinated  soda)  as  obtained,  through  the 
electrolysis  of  sea  water  or  of  solution  of  common  salt,  is  slightly 
more  efficient  than  calcium  hypochlorite,  forming  less  precipitate, 


284  MILITARY    HYGIENE. 

and  may  supersede  it  should  the  process  of  manufacture  become 
cheaper. 

The  amount  of  chloride  used  is  from  5  to  15  pounds  for  each  mil- 
lion gallons  of  water,  or  about  one  pound  to  100,000  gallons.  The 
common  practice  is  to  make  a  solution  of  ^  per  cent.,  that  is,  one 
pound  to  200  pounds  of  water,  in  concrete  tanks,  and  feed  it  to  the 
raw  water,  before  or  after  filtration  at  the  proper  rate  and  in  such 
manner  as  to  insure  a  quick  and  thorough  mixture.  The  contact 
period  should  be  at  least  one  hour  before  the  water  is  delivered  for 
use.  For  clear  water  simply  needing  organic  purification,  chloride 
of  lime  is  largely  taking  the  place  of  filtration.  For  turbid  water 
a  combination  of  both  methods  if  often  practised  and  highly  advan- 
tageous. When  added  to  the  reservoir  before  filtration,  chloride  of 
lime  is  said  to  materially  lessen  the  cost  of  operating  filters  by 
reducing  the  amount  of  coagulant  needed  and  (through  a  decrease 
of  organic  matter)  lengthening  the  runs  of  the  beds  between  wash- 
ings. On  the  other  hand,  by  its  inhibitive  action  upon  organic  life 
it  reduces  the  bacterial  efficiency  of  the  filter.  It  seems  best,  there- 
fore, to  have  recourse  to  a  rough  preliminary  filtration  if  any  pre- 
vious treatment  is  necessary  to  prevent  undue  clogging  of  the  sand 
filter,  and  use  the  chloride  in  the  effluent  from  the  latter. 

Of  all  chemical  methods  of  water  purification,  that  by  chloride  of 
lime  is  the  cheapest  and  one  of  the  most  efficient ;  it  is  also  one  of 
the  most  readily  adapted  to  the  needs  of  troops  in  the  field.  For  a 
small  party  of  men,  the  following  simple  device  is  recommended: 
a  teaspoonfnl  o'f  chloride,  leveled  off  by  rolling  a  pencil  over  it,  is 
rubbed  up  in  a  cup  of  water.  This  is  diluted  with  three  cupfuls  of 
water,  and  a  teaspoonful  of  this  dilution  is  added  to  a  two-gallon 
pailful  of  the  raw  water,  mixing  it  thoroughly.  This  will  give  four 
or  five  parts  of  chlorin  in  a  million  parts  of  water  and  will  destroy 
all  pathogenic  bacteria  without  leaving  any  taste  or  odor. 

Chlorin  gas,  as  water  sterilizer,  has  been  shown  by  C.  R.  Darnall, 
U.  S.  Army,  to  possess  certain  decided  advantages  over  hypochlorites 
because  of  its  uniform  strength  and  of  the  ease  and  accuracy  of  its 
dosage.  In  this  method,  the  purified,  dried  and  liquefied  gas  is  used, 
as  found  on  the  market,  in  steel  drums  holding  from  TOO  to  140 
pounds  each.  Chlorin  attacks  metals,  but  only  in  the  presence  of 
water  (by  liberating  oxygen)  ;  when  dry  it  can  be  kept  (liquefied) 
indefinitely  in  steel  drums  and  may  be  conducted  through  pipes  and 


WATER    PURIFICATION.  285 

valves  without  undue  corrosion.  Its  sterilizing  action  in  water  is 
due,  as  with  hypochlorites,  to  nascent  oxygen.  Owing  to  the  strong 
attraction  of  chlorin  for  hydrogen,  water  is  decomposed  with  forma- 
tion of  hydrochloric  acid  and  liberation  of  oxygen.  As  stated  before, 
this  acid  is  then  neutralized  by  the  carbonates  of  the  water. 

This  method  is  somewhat  more  expensive  than  the  use  of  hypo- 
chlorite,  but  cheaper  than  the  ozone  process  and  much  easier  to 
operate.  It  is  not  applicable,  however,  to  the  needs  of  troops  in  the 
field. 


FIG.  49. —  Diagram  of  the  Darnall  chlorin  apparatus  for  sterilization  of  water. 

The  apparatus  used  by  Darnall  (Fig.  49)  consists  essentially  of 
the  chlorin  container  (I)  and  a  pressure  regulator  (G)  actuating  the 
valve  (H)  which  admits  the  gas  to  the  water  to  be  sterilized 
(through  the  conducting  pipe  M)  in  such  manner  as  to  maintain 
the  predetermined  ratio  between  the  gas  and  the  water.  The  regu- 
lator is  a  casing  in  the  form  of  a  disk  made  up  of  two  horizontal 
compartments  separated  by  a  movable  diaphragm.  This  diaphragm 
is  connected  with  the  valve  by  a  lever,  closing  it  as  it  is  depressed 
and  opening  it  as  it  is  raised.  The  chlorin  enters  the  upper  com- 
partment, and  as  its  pressure  increases  the  depressed  diaphragm 
closes  the  valve  and  decreases  the  flow  of  gas.  The  lower  compart- 
ment is  connected  with  an  air  chamber  (O)  in  which  the  pressure  is 


286  MILITARY    HYGIENE. 

regulated  by  the  velocity  of  the  flow  of  the  raw  water;  as  this 
velocity  increases,  the  greater  is  the  action  of  the  small  auxiliary 
pump  E  (air  or  water  pump),  increasing  the  pressure  so  as  to  raise 
the  diaphragm,  open  the  valve  and  increase  the  current  of  chlorin. 
A  centrifugal  pump  (A)  raises  the  water  from  a  well  or  tank  (B) 
through  a  suction  pipe  (C)  into  the  main  (D)  where  the  chlorin  is 
discharged.  This  apparatus  admits  of  various  modifications  applic- 
able to  most  conditions  of  water-supply. 

The  official  board  appointed  to  investigate  this  method  came  to 
the  conclusion  that  it  is  as  efficient  as  purification  by  ozone  or  hypo- 
chlorites  and  more  reliable  in  operation ;  that  the  apparatus  is  very 
simple,  almost  automatic,  occupies  very  little  space,  and  can  be 
installed  in  connection  with  any  water-supply. 

WATER     BAG. 

Concerning  the  easiest,  cheapest  and  most  efficient  method  of 
water  purification  for  mobile  troops  in  the  field  and  in  active 
service,  the  preponderance  of  evidence,  at  this  time,  is  for  the 
chemical  treatment  by  calcium  hypochlorite  in  a  convenient,  port- 
able container.  This  is  officially  recognized,  in  our  service,  in  the 
shape  of  an  appliance*  designated  on  the  supply  table  as  "  Water 
Bag,  Field,  Sterilizing,"  and  described  as  follows  (Fig.  50)  : 

"  Consists  of  a  canvas  bag  of  specially  woven  flax,  20  inches  in 
diameter  and  28  inches  in  length,  sewn  to  -a  flat  galvanized  iron 
ring,  hinged  so  it  folds  at  one  diameter.  Spliced  at  four  equidistant 
points  on  the  ring  are  two  crossed  pieces  of  hemp  rope,  enabling 
the  bag  to  be  suspended  on  any  convenient  support  capable  of 
holding  the  weight  of  the  bag  when  filled  with  water,  which  is 
about  330  pounds.  Five  nickel,  spring  faucets  are  placed  at  equal 
spaces  about  the  bottom  edge  of  the  bag.  The  neck  of  these 
faucets  is  small  enough  to  enter  a  canteen,  which  can  be  filled  in 
10  seconds.  The  self-closing  faucets  prevent  wastage. 

"  The  purpose  of  the  bag*  is  not  for  transporting  water,  but  to 
provide  a  stationary  receptacle  in  which  water  can  be  held  long 
enough  to  sterilize  and  then 'distribute  it.  The  empty  bag  weighs 
from  7  to  7^  pounds  and  folds  into  a  convenient  package  for 
carriage  in  the  field. 

*  Devised  by  Major  Wm.  J.  L.  Lyster,  M.  C.,  U.  S.  A. 


WATER    PURIFICATION.  287 

"After  the  bag  is  suspended  and  filled  with  water,  it  is  sterilized 
by  the  addition  of  a  small  amount  of  hypochlorite  of  calcium.  This 
is  carried  in  measured  doses,  sealed  in  glass  tubes.  A  package  of 
60  of  these  tubes  weighs  10  ounces  and  measures  7^2  by  3^  by  4^ 
inches.  Packed  in  corrugated  paper  it  will  stand  rough  usage. 


FIG.  50. —  Bag  for  Sterilization  of  Drinking  Water  by  Calcium  Hypochlorite. 

"  The  tubes  themselves  are  3  inches  in  length  by  three-fifths  of  an 
inch  in  diameter  and  are  marked  with  a  file,  enabling  them  to  be 
easily  broken  in  the  fingers  without  fragments.  They  contain  from 
14  to  15  grains  of  calcium  hypochlorite.  This  chemical  contains 
from  30  to  32  per  cent,  chlorin,  which  forms  in  the  water  hypochlo- 
rous  acid  and  results  in  sterilizing  the  water.  The  process  is  one 
of  oxidation.  In  the  strength  used,  waters  highly  infected  are  ren- 
dered safe.  Of  course,  in  such  strength  (1-500,000)  grossly  pol- 
luted water,  such  as  sewage,  will  not  be  rendered  safe.  Water  ordi- 
narily used  will  be  entirely  safe  after  being  so  treated.  As  the 
chemical  acts  more  efficiently  in  clear  waters,  a  filter  cloth,  to  be 


288  MILITARY    HYGIENE. 

fastened  over  the  opening  of  the  bag  and  weighing  i  ounce,  is 
provided,  or  water  may  be  strained  through  a  blanket.  The  bag 
is  filled  after  it  is  in  place.  Suspended  matter,  such  as  clay,  is 
largely  removed  and  not  left  to  interfere  with  the  action  of  the 
chlorin. 

"  Comprehensive  experiments  demonstrate  the  bacteriological  effi- 
ciency of  the  appliance.  Tbe  organisms  causing  typhoid  fever,  the 
dysenteries,  including  amoebic  or  tropical  dysentery,  and  ciliates 
are  promptly  destroyed.  Even  in  the  vegetative  form  amoebae  are 
killed  in  15  minutes ;  ordinarily  5  to  10  minutes  suffice  after  the 
addition  of  the  powder  to  render  the  water  safe  to  drink.  Ex- 
posure of  30  minutes  has  been  found  to  destroy  all  amoebae  and 
ciliates  under  most  severe  conditions  in  a  test." 

Other  chemicals  worth  mentioning  are : 

Potassium  permanganate  has  long  been  used  as  a  water  purifier 
and  yields  fairly  good  results.  A  sufficient  quantity  must  be  added 
to  the  water  to  impart  a  faint  pink  tinge  which  should  persist  for 
half  an  hour.  From  5  to  10  centigrams  to  a  liter  (about  a  grain 
to  the  quart)  is  required  in  average  water  to  oxidize  and  destroy  the 
organic  matter  and  bacteria,  but  its  action  is  very  slow  and  some- 
what uncertain.  Vaillard,  however,  declares  that  in  water  previously 
clarified,  2  to  4  centigrams  to  a  liter  will  destroy,  in  30  to  40  minutes, 
all  pathogenic  and  sporeless  bacteria.  After  using  permanganate  it 
is  well  to  filter  the  water  to  get  rid  of  the  brownish  precipitate  of 
manganese  oxid,  although  probably  innocuous.  The  water  often 
retains  an  unpleasant  taste. 

In  the  Lambert  process,  manganese  sulphate,  aluminum  sulphate 
and  an  alkaline  carbonate  are  added  to  the  permanganate,  so  that 
the  water  is  clarified  as  well  as  sterilized. 

Sodium  bisulphate  has  been  found  an  efficient  destroyer  of  the 
ordinary  pathogenic  bacteria  in  water.  To  a  quart  of  water  is  added 
a  3O-grain  tablet  of  this  salt  sweetened  with  saccharin  and  flavored 
with  oil  of  lemon  (as  advised  by  Firth)  ;  the  water,  which  acquires 
a  pleasant  acidulous  taste,  may  be  drunk  in  about  20  minutes.  It 
is  doubtful  whether  the  use  of  such  water  could  be  long  continued 
on  account  of  its  probable  laxative  effect. 

Copper  sulphate  has  been  highly  recommended  as  germicide  and 
algicide.  In  the  proportion  of  I  to  I,CXDO,OOO-IO,OOO,OOO,  it  will 
destroy  most  of  the  algae  which  often  infest  reservoirs  and  drains. 


WATER    PURIFICATION  289 

If  evenly  distributed  and  the  water  is  filtered  afterward  it  can  safely 
be  used  in  the  above  proportions  in  drinking  water.  It  cannot  be 
depended  upon  to  destroy  all  micro-organisms  except  in  dangerous 
doses  (1/50,000  to  1/100,000). 

Citric  acid,  in  the  proportion  of  one  ounce  to  16  gallons  of  water, 
is  well  spoken  of  as  a  corrective  of  the  repulsive  fishy  taste  and 
odor  due  to  the  decay  of  minute  algae  found  in  certain  waters,  and 
which  remain  unaffected  by  filtration  and  boiling. 

Those  chemical  agents  which  act  as  coagulants  and  precipitate 
matters  in  suspension  will  be  considered  under  filtration. 


CHAPTER    XXIII. 
WATER  PURIFICATION  (CONTINUED). 

FILTRATION. 

Filtration  is  the  method  of  purifying  water  in  which  we  seek  to 
imitate  the  natural  percolation  taking  place  in  nature,  through  the 
superficial  porous  strata  of  the  earth,  whereby  contaminated  surface 
water  is  transformed  into  the  pure  water  of  springs  and  deep  wells. 

Filtration  is  chiefly  a  mechanical  process ;  that  is  to  say,  the  action 
of  a  filter  is  mainly  that  of  a  very  fine  strainer  and  therefore  limited 
to  the  suspended  or  insoluble  matters  of  the  raw  water.  We  may, 
therefore,  expect  to  see  the  turbidity,  sediment  and  bacteria  largely 
or  entirely  disappear,  while  organic  matter  and  other  substances  in 
solution,  such  as  those  producing  hardness,  color  and  smell,  are 
removed  only  to  a  slight  extent,  if  at  all.  Besides  this  mechanical 
action,  however,  we  also  often  find  the  evidences  of  a  biological 
action  in  filters,  varying  in  degree  according  to  the  method  pursued. 
We  know  that  bacteria  are  more  minute  than  the  pores  of  a  Berke- 
f eld  or  Chamberland  filter,  or  the  spaces  between  grains  of  fine  sand  ; 
if  they  do  not  pass  through  with  the  water,  it  is  because  of  a  molec- 
ular attraction  whereby  they  adhere  to  the  grains  of  sand  or  the 
walls  of  the  pores,  an  adhesion  aided  and  strengthened  by  the 
viscous  organic  matter  found  in  most  waters  and  which  lines  the 
pores,  or  smears  the  grains  of  sand  of  filters.  Thus  arrested,  the 
bacteria  are  subjected  to  unfavorable  conditions  which  soon  bring 
about  their  oxidation  and  destruction.  It  readily  happens,  however, 
that  if  certain  precautions  are  neglected,  the  bacteria  find  suitable 
conditions  for  their  multiplication  and  gradually  extend,  by  growth, 
through  the  filter  into  the  filtered  water  which  thus  may  become 
worse  polluted  than  the  raw  water.  Therefore,  although  filtration 
when  properly  carried  out  is  a  very  efficient  means  of  purification, 
it  may  also,  when  carelessly  conducted,  be  the  source  of  serious 
contamination. 

Whenever  coagulants  are  used,  previous  to  filtration,  there  is  a 
chemical  action  added  to  the  mechanical  and  biological  actions.  In 
quick  mechanical  filtration,  there  is  no  time  for  any  biological  action 
to  take  place,  the  organic  matter  and  bacteria  being  simply  removed 
instead  of  being  oxidized. 

290 


WATER   PURIFICATION    (CONTINUED). 


291 


Domestic  Filters. 

Of  these  filters  the  number  is  legion.  The  best-known  types  and 
the  most  effective,  like  the  Pasteur-Chamberland  and  Berkefeld,  con- 
sist of  unglazed  porcelain  cylinders  made  from  a  mixture  of  kaolin 
and  other  special  clays.  The  Berkefeld  filter  was  also  formerly 
made  of  infusorial  earth  (microscopic  skeletons  of  diatoms). 
Finely  powdered  asbestos  is  sometimes  added  to  the  clay  as  in  the 
Mallie  or  Porcelain-Adamant  filter.  They  are  mostly  in  the  form 
of  hollow  cylinders  called  "  candles  "  or  "  bougies,"  closed  at  one 
end  and  open  at  the  other  or  nipple-shaped  end  (Fig.  51).  Each 
bougie  is  inclosed  in  a  glass  or  metal  jacket  with  an  intervening  space 


FIG.  51. —  Section  of 

Berkefeld  filter. 

(Munson.} 


FIG.  52.— Battery  of  Berkefeld  filters. 
(Munson.) 


between.  The  head  of  the  jacket  being  screwed  to  a  water  tap,  the 
raw  water  enters  into  the  space  surrounding  the  bougie  and,  passing 
through  its  walls  into  the  hollow  interior,  discharges  at  the  nipple 
end.  For  proper  functioning,  the  pressure  should  be  at  least  equal 
to  one  atmosphere.  These  cylinders  can  be  set  together  and  operated 
in  batteries  (Fig.  52).  In  the  field  such  batteries  are  supplied  with 
a  hand-pump  attachment  (Fig.  53).  The  output  is  small,  seldom 
exceeding  five  quarts  an  hour  per  cylinder,  being  somewhat  larger 
with  the  Berkefeld  than  with  any  of  the  other  kinds. 


292 


MILITARY    HYGIENE. 


These  filters  not  only  clarify  but  are  also  capable  of  purifying 
the  water.  When  put  in  operation,  after  sterilization,  the  Chamber- 
land  and  Berkefeld  furnish  at  first  a  water  absolutely  sterile.  But 
it  is  noticed  that  the  output  decreases  rapidly,  falling  from  4  to  5 


FIG.  53. —  Berkefeld    filter    with    pump    for 
field  use.     (Munson.) 


FIG.  54. —  Cincinnatus 
filter  with  scraping  de- 
vice controlled  by  wheel 
at  bottom,  and  reservoir 
above. 


quarts  an  hour  to  2}  i  or  even  less  in  the  course  of  three  or  four 
days ;  at  the  same  time  the  bougie  becomes  covered  with  a  coating 
of  the  impurities  in  suspension,  and  germs  begin  to  appear  in  the 
filtered  water.  These  germs  did  not  pass  through  with  the  raw 
water  but  result  from  the  growth  of  those  deposited  upon  the  sur- 
face, gradually  extending  along  the  pores  through  the  walls  of  the 
bougie.  They  are  nearly  always  harmless  water  saprophytes,  the 


WATER    PURIFICATION    (CONTINUED).  293 

conditions  being  generally  unfavorable  to  tbe  multiplication  of 
pathogenic  bacteria.  It  is  quite  possible,  however,  that,  under  favor- 
able conditions  such  as  suitable  temperature  of  the  water  and  suffi- 
cient nutrient  medium,  the  germs  of  typhoid  fever  and  cholera  could 
also  grow  through  these  filters.  It  is -necessary  therefore  that  they 
should  be  brushed  every  day,  and  sterilized  in  boiling  water  at  least 
every  3  or  4  days.  This  cleansing  and  sterilization  require  special 
care,  such  as  can  seldom  be  given  in  households  or  military  organiza- 
tions, so  that,  outside  of  laboratories,  these  filters  are  seldom  of 
much  practical  utility. 

In  the  Cincinnatus  filter  type  (Fig.  54),  the  water  when  filtered 
passes  into  the  reservoir  above.  It  is  cleaned  by  opening  the  flush 
cock  and  revolving  the  wheel ;  this,  by  special  device,  reverses  the 
filtered  water  and  scrapes  the  mud  off  the  surface  of  the  tube.  Such 
filter  can  be  depended  upon  for  thorough  clarification  and  a  fair 
degree  of  bacterial  efficiency. 

SAND  FILTRATION. 

Sand  filtration  is  the  method  of  water  purification  on  a  large  scale 
used  by  towns  and  other  large  communities.  It  is  applied  in  two 
different  ways,  either  according  to  the  original  sand-bed  or  English 
system,  or  the  more  recent  mechanical  or  American  system. 

In  the  English  system,  the  plant  consists  of  a  certain  number  of 
sand  beds,  each  capable  of  independent  operation  (Fig.  55).  The 
average  sand  bed  is  one  acre  in  area  and  about  four  feet  deep.  It 
consists,  from  the  bottom  upward,  of  broken  stone,  gravel  and 
sand;  the  broken  stone  and  gravel  forming  a  layer  one  foot  thick, 
and  the  sand  another  layer  three  feet  deep.  The  broken  stone  is 
graded  from  one  or  two  inches  in  diameter  to  about  1/5  of  an  inch 
or  less.  The  sand  should  be  clean,  free  from  lime  and  clay,  the 
grains  ranging  from  0.30  to  0.40  millimeter.  The  finer  the  sand  the 
better  the  purification  and  the  lesser  the  depth  of  the  surface  layer 
becoming  soiled,  but  the  smaller  the  output.  The  bed  is  thoroughly 
underdrained  with  lateral  drains  of  open-jointed  tile  emptying  into 
a  central  conduit.  The  bottom  and  sides  of  the  compartment  con- 
taining the  bed  are  carefully  cemented  and  made  water-tight.  A 
roof  is  necessary  wherever  the  winter  is  severe  and  much  ice  forms ; 
by  excluding  light  it  also  prevents  the  growth  of  algae  and  other 
microscopic  plants,  sometimes  very  troublesome  in  summer.  In  Eng- 


294 


MILITARY    HYGIENE. 


land  and  Holland  the  beds  are  mostly  left  open.  Unless  the  water 
is  pretty  clear  one  or  more  settling  basins  are  necessary ;  the  more 
complete  is  this  preliminary  sedimentation  the  more  rapid  and 
effective  will  be  the  functioning  of  the  filter.  Turbid  water  clogs 
the  sand  bed  and  requires  frequent  and  expensive  cleaning. 

The  suspended  matters  in  water  are  retained  on  the  surface  of 
the  sand  forming  a  sediment  which  becomes  a  much  finer  strainer 
than  the  sand  itself.  This  sediment  (Schmutsdecke  of  the  Germans) 


Supply   to  Filte 


it- 


-filter- 


-.-Filter; 


-Outlet  Pipet  Inlet  Fipei- 


Sedimentation    ~ 


BaSin 


Supply  to  filter. 

FIG.  55.—  Plan  of  filter  beds  at  Albany,  N.  Y. 

consists  of  mineral  and  organic  substances  in  variable  proportions 
according  to  the  character  of  the  water.  In  water  relatively  clear, 
as  in  most  of  our  eastern  rivers,  it  is  mostly  made  up  of  organic 
matter,  especially  miscroscopic  algae  and  diatoms,  which  by  the  swell- 
ing up  of  their  cell  membranes  form  a  slimy,  gelatinous  layer  in 
which  nearly  all  the  micro-organisms  of  the  water  are  caught.  This 
gelatinous  substance  (bacterial  jelly  or  zooglcea),  which  also  smears 
each  grain  of  sand  in  the  upper  layer,  plays  an  important  part  in 
the  process  of  sand  filtration,  for  it  is  after  its  formation  that  the 
filter  reaches  its  highest  degree  of  efficiency,  the  bacteria  caught  in 
its  meshes  being  promptly  oxidized  and  destroyed.  But,  after  a 
while,  the  sediment  becomes  so  thick  and  impervious  that  the  rate 
of  filtration  is  very  much  reduced.  It  is  then  necessary  to  clean  the 
bed,  that  is,  remove  the  gelatinous  sediment  and  one  or  two  inches 
of  the  surface  sand.  When  the  water  contains  much  fine  silt  and 
the  organic  gelatinous  sediment  is  scant,  several  inches  of  sand  may 


WATER    PURIFICATION    (CONTINUED).  2Q5 

become  clogged  and  require  removal.  Sand  filters  are  generally 
cleaned  every  3,  4  or  5  weeks  in  winter,  depending  upon  the  amount 
of  impurities  in  the  water,  and  much  less  frequently  in  summer. 
In  improved  plants  (as  in  Washington,  D.  C.),  the  process  of  clean- 
ing is  largely  mechanical  and  automatic;  the  sand  is  shoveled  into 
movable  ejectors,  aspirated  into  washers,  then  conveyed  into  "bins 
for  storage  and  distribution.  The  filters  may  be  scraped  several 
times  before  new  sand  is  put  on,  provided  the  sand  bed  is  never 
reduced  to  a  thickness  of  less  than  two  feet.  In  still  more  recent 
plants  the  bed  is  cleaned  by  raking  and  flushing  without  removal  of 
sand. 

After  the  cleaning,  leveling  and  smoothing  of  the  surface,  the  bed 
is  refilled  with  filtered  water,  from  below,  through  the  underdrains. 
This  is  in  order  not  to  break  or  roughen  the  surface.  After  clean- 
ing there  is  a  reduction  in  the  bacterial  efficiency  of  the  filter ;  more 
bacteria  will  pass  through  if  full  pressure  is  put  on  at  once;  it  is 
better,  therefore,  to  start  again  slowly  and  gradually  increase  the 
rate.  The  maximum  rate  of  downward  flow  should  seldom  exceed 
four  inches  an  hour. 

In  most  of  our  southern  and  western  rivers  the  abundant  clay 
and  sand  in  suspension  absorb  most  of  the  organic  matter  so  that 
no  gelatinous  layer  forms.  The  water  of  such  rivers  would  clog 
the  filter  in  a  few  days  and  must  therefore  receive  special  treatment. 
It  is  first  run  through  one  or  more  settling  basins,  and  then  a  coagu- 
lant is  added  to  it,  as  in  mechanical  filtration.  Simple  sedimentation, 
that  is  to  say,  the  natural  settling  down  of  matters  in  suspension  in 
quiet  waters,  produces  of  itself  a  marked  degree  of  purification. 
Not  only  do  the  mineral  particles  subside,  thus  clarifying  the  water, 
but  in  so  doing  attract  the  floating  bacteria  and  carry  them  down ; 
this  is  one  of  the  sanitary  advantages  of  large  reservoirs  admitting 
of  long  storage.  The  addition  of  a  coagulant  causes  the  microscopic 
atoms  of  silt  (smaller  than  the  pores  of  the  sand)  to  coalesce  in 
larger  and  heavier  particles  which  settle  down  as  a  flocculent  pre- 
cipitate, forming  a  sediment  which  takes  the  place  of  the  gelatinous 
layer  of  clear  rivers.  This  addition  of  a  coagulant,  previous  to  sand 
filtration,  is  always  desirable  in  turbid  waters.  (See  page  297.) 

Lime  and  sulphate  of  iron,  in  combination,  have  been  used  to 
precipitate  sewage  for  many  years.  Lately  this  combination  has 
been  adapted  to  water  purification,  on  account  of  its  cheapness  and 


296  MILITARY    HYGIENE. 

the  softening  action  of  the  lime  when  added  to  water  containing  an 
excess  of  carbonates.  The  iron  hydrate  is  the  active  coagulating 
agent;  if  magnesium  is  present,  magnesium  hydrate  also  acts  as  a 
coagulant.  The  process  is  particularly  adapted  to  turbid  waters 
containing  calcium  and  magnesium  bicarbonates,  and  is  largely  used 
in  the  Middle  and  Western  States.  At  Saint  Louis,  Mo.,  it  is 
claimed  that  it  removes  99  per  cent,  of  bacteria  and  reduces  the 
turbidity  from  1,200  to  10. 

In  Richmond,  Va.,  the  result  of  sedimentation  and  coagulation  is 
so  satisfactory  that  filtration  is  dispensed  with.  The  reduction  in 
turbidity  is  76  per  cent,  in  the  settling  basins  and  reaches  a  total  of 
96  per  cent,  in  the  coagulating  basins,  while  the  bacteria  seldom 
exceed  200  to  300  per  c.  c.,  and  the  colon  bacillus  is  hardly  ever 
found  in  the  effluent. 

The  experience  of  recent  years  in  Philadelphia  tends  to  prove  that, 
where  a  large  amount  of  the  coarser  suspended  matter  consists  of 
small  organic  life  which  would  not  be  thrown  down  by  precipitation, 
a  preliminary  rough  upward  filtration  (through  coarse  gravel  and 
crushed  furnace  slag,  topped  with  compressed  sponge)  doubles  the 
yield  of  the  sand  beds,  besides  insuring  a  uniformly  better  quality  of 
effluent.  These  preliminary  filters  do  in  a  few  hours  what  it  may 
take  weeks  to  accomplish  with  sedimentation  basins,  and  much  more 
cheaply. 

The  changes  produced  by  effective  sand  filtration  are:  complete 
removal  of  solids  in  suspension,  a  reduction  of  at  least  50  per  cent, 
in  free  ammonia,  35  per  cent,  in  albuminoid  ammonia  and  25  per 
cent,  in  oxidizable  organic  matter,  and  an  increase  of  25  to  30  per 
cent,  in  nitrates.  It  should  also  remove  at  least  99  per  cent,  of  the 
micro-organisms  of  the  raw  water,  so  that  the  remaining  bacteria 
will  not  exceed  50  to  the  cubic  centimeter. 

If  a  disinfectant  is  judged  necessary,  it  is  best,  as  a  general  rule, 
to  use  it  after  filtration,  for  if  added  before,  it  may  destroy  or  injure 
the  efficiency  of  the  filter  by  reducing  its  bacterial  life  and  activity. 

The  filter  plant  of  Washington,  D.  C.,  one  of  the  latest  and  most 
complete  in  this  country,  consists  of  29  sand  beds,  each  one  acre  in 
size,  in  basins  of  concrete,  completely  covered.  The  water  is  taken 
from  the  Potomac  River,  14  miles  above  the  city,  and  allowed  to 
settle  in  three  successive  reservoirs.  The  beds  are  cleaned  every  six 
weeks  in  winter  and  only  once  or  twice  in  summer,  the  thickness  of 


WATER   PURIFICATION    (CONTINUED).  297 

sand  removed,  owing  to  the  large  proportion  of  fine  clay  in  the  raw 
water,  being  6  to  12  inches.  This  cleaning  is  mostly  automatic,  as 
noted  above.  The  cost  of  operation,  including  interest  on  cost  of 
construction,  is  0.9  of  a  cent  per  1,000  gallons.  The  output  exceeds 
200  gallons  per  capita.  During  the  year  1906,  the  number  of  bac- 
teria in  the  filtered  water  ran  from  17  to  39  per  cubic  centimeter. 

MECHANICAL    FILTRATION. 

This  system  is  of  American  origin  and  extensively  used  in  this 
country.  It  is  particularly  adapted  to  very  turbid  waters  in  which 
no  organic  gelatinous  sediment  forms,  as  well  as  to  highly  colored 
waters;  it  is  the  most  practicable  system  of  purification  for  the 
water  of  the  lower  Mississippi  and  many  other  western  rivers.  It  is 
also  the  system  best  adapted  to  military  posts  or  small  communities. 
It  consists  in  rapid  sand  filtration,  after  sedimentation  and  the  addi- 
tion of  a  coagulant.  Its  efficiency  depends  chiefly  upon  the  use  of 
coagulants ;  these  do  not  effect  purification  by  destroying  or  inhibit- 
ing the  bacteria  contained  in  the  water ;  they  simply  cause  the  forma- 
tion of  a  precipitate  of  a  more  or  less  flocculent  character  which 
entangles  and  surrounds  all  suspended  particles,  including  the  bac- 
teria. Thus  clay,  sand,  considerable  organic  and  coloring  matter, 
and  bacteria,  are  removed ;  but  the  bacteria  thus  carried  down  are 
not  killed,  for  cultures  can  be  made  from  the  precipitate.  Water 
thus  treated  and  allowed  to  stand  until  the  precipitate  has  settled  to 
the  bottom  is  clear  and  brilliant,  and  nearly  sterile  (Darnall). 

The  coagulants  most  commonly  used  are  alum  (aluminum  and 
potassium  sulphate),  aluminum  sulphate  and  iron  sulphate.  When 
either  of  these  chemicals  is  added  to  the  water,  it  is  decomposed  by 
the  action  of  the  carbonates  present  in  the  water,  with  formation  of 
a  flocculent  precipitate  of  aluminum  hydroxid  or  ferrum  hydroxid, 
and  of  another  of  basic  sulphates,  the  latter  to  some  extent  helping 
the  former  in  carrying  down  the  suspended  impurities.  Should  the 
water  be  lacking  in  natural  carbonates  it  will  be  necessary  to  add 
them. 

In  the  mechanical  (gravity  or  open)  filter  plant,  the  raw  water  is 
conveyed  or  pumped  into  settling  tanks,  entering  near  the  bottom 
after  having  received  a  graded  quantity  of  coagulant,  usually  one  to 
two  grains  per  gallon.  It  rises  until  it  overflows  into  the  filter  tanks, 
leaving  behind,  in  the  settling  tanks,  much  of  the  precipitated  sus- 


298 


MILITARY    HYGIENE. 


pended  impurities.  The  filter  tank  is  circular,  of  wood  or  steel 
(Fig.  56),  or  rectangular,  of  concrete.  It  is  filled  with  sand  through 
which  the  water  passes  at  a  rate  50  to  60  times  faster  than  through 


FIG.  56. —  Jewell  gravity  filter  with  rake.     (N.  Y.  Continental  Jewell  Filtration 

Co.) 

an  ordinary  bed  filter,  the  best  average  rate  being  105  gallons  an 
hour  per  square  foot  of  area.  The  sand  is  somewhat  larger  than 
in  the  ordinary  filter,  but  should  be  of  more  uniform  size  to  prevent 
"  breaking  "  or  "  channelling  "  in  the  process  of  washing.  When- 
ever the  sand  becomes  clogged,  once  or  twice  a  day,  it  is  cleaned,  in 
circular  tanks,  by  using  a  reverse  or  upward  current  of  filtered 
water,  being  meanwhile  thoroughly  stirred  by  a  revolving  rake,  the 
impurities  overflowing  over  the  edge  of  the  tank. 

In  plants  using  concrete  rectangular  tanks,  the  revolving  rake  is 
replaced  by  the  "  air  wash  "  device,  the  sand  being  washed  by  driving 
innumerable  jets  of  air  and  water  alternately  through  it  from  the 
bottom,  the  air  for  agitation  and  scrubbing  and  the  water  for  rinsing. 
This  system  is  likewise  applied  to  circular  tanks.  (Fig.  57.) 

The  so-called  pressure  mechanical  filter  is  in  an  entirely  closed 
receptacle  through  which  the  w'ater  is  forced  under  pressure.  (Fig. 
58.)  When  the  location  is  favorable,  as  when  the  plant  is  'below 
the  source  of  supply,  this  system  is  indicated  and  satisfactory.  Pres- 
sure filters  are  readily  cleansed  and  operated,  and  in  the  case  of 


WATER    PURIFICATION    (CONTINUED). 


299 


FIG.  57. —  Continental  "  air  wash  "  gravity  filter. 

small  communities  quite  economical.  Nevertheless,  they  are  not  as 
reliable  as  gravity  filters  and  cannot  be  recommended  for  drinking 
water  unless  supplemented  by  the  use  of  chloride  of  lime. 


FIG.  58. —  New  York  sectional  wash  horizontal  pressure  filter. 


300 


MILITARY    HYGIENE. 


The  efficiency  of  the  mechanical  filter  is  not  quite  as  high  as  that 
of  the  best  sand-bed  filter,  seldom  removing  more  than  98  per  cent, 
of  the  bacteria ;  but  it  is  25  per  cent,  cheaper  in  total  first  cost  and 
requires  an  area  of  only  about  one-thirtieth  the  size. 

According  to  Rudolph  Hering :  "  With  good  design  and  construc- 
tion, and  with  good  operation,  these  two  classes  of  filters  can  and 
do  remove  about  equally  well  both  pathogenic  and  ordinary  bacteria." 

THE   DARN  ALL   FILTER.* 

This  apparatus  is  an  ingenious  adaptation  of  the  principle  of 
mechanical  filtration  to  the  needs  of  troops  in  the  field.  It  consists 
of  a  galvanized-iron  tank,  two  water  cans,  a  siphon  filter  and  cloth, 


FIG.  59. —  The  Darnall  filter,  packed. 

a  siphon  primer  (small  hand  pump  to  start  the  flow  of  water)  and  a 
crate  (Figs.  59,  60,  61).  The  essential  part  is  the  cylindrical  metal 
framework  of  the  siphon  over  which  is  wrapped  the  filtering  mate- 
rial, a  closely  woven  cotton  fabric.  This  is  placed  in  the  tank  filled 


*  Devised  by  Major  Carl  R.  Darnall,  Medical  Corps,  U.  S.  Army. 


WATER   PURIFICATION    (CONTINUED). 


301 


with  raw  water  to  which  the  precipitant  has  already  been  added, 
and  the  water,  after  passing  through  the  filtering  cloth  into  the 
cylinder,  is  discharged  by  siphonage  into  the  water  can. 

As  matters  in  suspension  deposit  upon  the  cloth  and  the  flow  of 
water  becomes  much  diminished,  the  filter  should  be  taken  out  and 
brushed,  but  when  the  brushing  no  longer  restores  a  full  flow,  the 


FIG.  60. —  The  Darnall  filter,  ready  for  operation. 

cloth  must  be  removed,  washed  and  put  aside  to  dry ;  a  new  cloth 
is  put  on  and  sterilized  in  the  can  by  siphoning  boiling  water 
through  it. 

The  precipitant  consists  of  alum  and  sodium  carbonate  in  such 
proportions  as  to  neutralize  each  other.    Five  grains  of  alum  to  the 


302 


MILITARY    HYGIEKE. 


gallon  is  sufficient  for  the  most  grossly  polluted  water.  Each  gallon 
of  water  treated  with  this  amount  of  alum  and  its  equivalent  of  soda 
and  then  filtered,  will  contain,  in  addition  to  its  original  chemical 
constituents,  about  2.5  grains  of  sodium  sulphate,  0.93  of  potassium 
sulphate,  and  0.7  of  carbon  dioxid,  all  of  which  are  harmless  if  not 
beneficial.  The  alum  and  soda  may  be  used  in  separate  solutions 
fed  automatically,  but  for  use  with  marching  troops  and  in  temporary 
camps  it  is  more  convenient  to  use  them  already  mixed,  in  the  form 
of  a  stable  powder,  one  pound  of  which  is  sufficient  for  500  gallons 
of  water. 

This  filter  complete  (with  crate)  weighs  52  pounds  and  will  de- 
liver about  200  gallons  of  water  in  four  hours.  It  completely  clari- 
fies the  water.  Its  bacterial  efficiency  is  about  98  per  cent,  with 


FIG.  61. —  Filtering  cylinder  of  the  Darnall  filter,  with  and  without  filtering 

cloth. 

ordinary  waters,  and  more  under  favorable  conditions,  therefore 
comparing  favorably  with  most  municipal  filtering  plants.  This 
apparatus  cannot  be  depended  upon  for  the  certain  elimination  of  all 
pathogenic  bacteria,  as  with  heat  sterilizers,  but  it  purifies  ordinary 
waters  to  a  degree  that  renders  them  reasonably  safe.  It  does  not 


WATER    PURIFICATION"    (CONTINUED). 


303 


require  any  fuel  except  for  heating  water  to  sterilize  the  filter  cloths, 
once  daily;  it  furnishes  plenty  of  clear  water,  unchanged  in  tem- 
perature and  taste,  within  an  hour  after  getting  into  camp ;  the  whole 
outfit  is  simple,  cheap,  easily  transportable  and  workable  in  any 
situation.  It  has  been  carefully  investigated  by  a  board  of  medical 
officers  and  its  use  in  the  field  recommended. 


FIG.  62. — The  Japanese  field  filter.     (Eshitzi  filter.) 

THE  JAPANESE  FIELD  FILTER  (Eshitzi  Filter). 
During  the  Russo-Japanese  War,  the  Japanese  used  another  sim- 
ple and  practical  adaptation  of  the  principle  of  the  mechanical  filter. 
(Fig.  62.)  It  consists  essentially  of  a  conical  canvas  bag  of  a  capac- 
ity of  24  gallons,  with  two  spouts  or  branches  near  the  point ;  these 
spouts  are  filled  with  charcoal  and  sponge  disks  and  constitute  the 


304  MILITARY    HYGIENE. 

filters  proper ;  the  point,  or  apex,  receives  the  sediment.  The  whole 
apparatus  is  suspended  between  the  branches  of  a  tripod. 

Two  powders  are  used.  The  first  (A)  consists  of  potassium  alum, 
potassium  permanganate  and  (to  give  bulk)  aluminum  silicate;  the 
second  (B),  chiefly  of  aluminum  silicate  and  of  small  amounts  of 
tannic  acid  and  hydrochloric  acid.  The  filter  having  been  filled,  a 
suitable  quantity  of  powder  A,  enough  to  plainly  discolor  .the  water, 
is  added  and  stirred  up ;  after  a  few  minutes,  about  half  as  much  of 
powder  B  is  stirred  in  until  the  discoloration  caused  by  the  first  has 
been  removed.  Then  the  water  is  allowed  to  stand  15  or  20  minutes 
for  the  bactericidal  action  and  subsidence  of  the  precipitate,  after 
which  the  lateral  spouts  are  untied  and  the  water  allowed  to  pass 
through.  The  hydrochloric  acid  in  powder  B  facilitates  the  decom- 
position of  the  permanganate,  while  the  tannic  acid  removes  the 
color  imparted  to  the  water. 

The  result  is  quite  satisfactory  with  comparatively  clear  water, 
but  much  less  so  with  turbid  water.  The  output  is  small  and  the 
disinfection  of  the  apparatus  difficult. 

GRANULAR  FILTERS.  —  This  name  is  given  to  devices  whose  filter- 
ing material  consists  of  some  hard  granular  substance  other  than 
sand,  often  contained  in  asbestos  cloth.  Bone  charcoal  was  formerly 
commonly  used  for  this  purpose;  it  has  the  property  of  removing 
coloring  matters,  but  on  account  of  its  porous  nature  soon  absorbs, 
and  becomes  impregnated  with,  the  impurities  of  the  water,  when 
the  only  way  of  sterilizing  it  is  by  calcination.  It  also  yields  nitro- 
gen and  phosphates  which  favor  the  growth  of  bacteria  in  water. 
Vegetable  charcoal,  coke  and  spongy  iron  are  more  or  less  efficient 
against  suspended  matters  and  micro-organisms,  but  soon  deterio- 
rate and,  unless  constantly  watched,  are  likely  to  yield  more  bacteria, 
saprophytic  and  pathogenic,  than  are  contained  in  the  raw  water. 

IMPROVISED    FILTERS. 

In  camps,  filters  for  the  clarification  of  water  can  be  readily  im- 
provised if  sand  be  available,  and  a  certain  degree  of  purification 
can  likewise  be  obtained.  But,  on  the  other  hand,  it  must  be  remem- 
bered that  such  filters,  unless  they  can  be  washed  or  sterilized,  may 
soon  become  infected  and  that  clarification  may  be  obtained  at  the 
expense  of  purification. 

Hard,  clean  sand  is  the  best  material  for  improvised  filtration. 


WATER    PURIFICATION. 


305 


For  reasons  stated  above,  bone  charcoal  is  not  suitable.  If  sand  be 
placed  over  pebbles  and  coarse  gravel  in  a  barrel,  we  have  the  usual 
sand  filter  on  a  small  scale;  through  the  perforated  bottom  the 
filtered  water  is  discharged  into  another  barrel  or  can.  If  the  water 
is  turbid  it  should  first  be  treated  with  alum,  2  or  3  grains  to  the 
gallon.  In  the  absence  of  sand,  this  treatment  by  alum  may  be 
sufficient  of  itself,  but  with  water  likely  to  be  contaminated  with 
sewage,  it  should  be  followed  by  boiling. 


FIG.  63. —  Double  barrel  improvised  filter. 

If  a  hogshead  and  a  barrel  are  available,  the  latter,  with  perforated 
bottom,  is  placed  inside  the  former  upon  a  bed  of  coarse  gravel  or 
pebbles  and  the  interspace  filled  with  gravel  and  sand ;  the  water  is 
gently  poured  or  sprinkled  over  the  sand  and,  after  filtration,  rises 
up  to  its  level  in  the  barrel.  (Fig.  63.)  The  upper  layer  of  sand 
should  be  frequently  scraped  out  and  washed  or  replaced  by  fresh, 
clean  sand. 

Another  expedient  is  to  dig  a  pit  at  a  distance  of  a  few  feet  from 
the  river's  edge,  where  the  bank  is  sandy,  and  let  the  water  percolate 
through  the  intervening  sand  into  it ;  or,  again,  a  trench  may  be  dug 
connecting  the  river  with  the  pit,  then  boxed  and  filled  with  sand. 

The  so-called  "  Venetian  cistern  "  can  also  be  readily  improvised 
in  certain  situations.  It  consists  (Fig.  64)  of  a  pit  with  sloping 
walls  of  clay  (D)  lined  with  cement  (C),  and  of  a  circular  wall  of 


306 


MILITARY    HYGIENE. 


clay,  likewise  cemented,  in  the  center;  the  interval  is  filled  with 
clean  sand  (B)  and  receives  the  raw  water  (A)  which,  after  filter- 
ing through,  passes  into  the  central  well  (E). 


FIG.  64. —  Venetian  cistern. 

In  certain  arid  regions  where  cactus  plants  are  common,  the  leaves 
(or  rather  joints)  of  these  plants,  cut  up  and  crushed,  are  quite  use- 
ful to  clarify  water  in  the  absence  of  alum.  They  contain  an  abund- 
ant mucilaginous  juice  which,  like  alum,  causes  the  very  fine  silt 
suspended  in  the  water  to  coalesce  into  larger  and  heavier  particles 
which  precipitate,  carrying  down  with  them  a  large  proportion  of 
the  micro-organisms. 


CHAPTER    XXIV. 
FOOD. 

Food  is  any  digestible  substance  introduced  into  the  alimentary 
canal  for  the  nourishment  of  the  body. 

All    foodstuffs   may   be   conveniently   divided    and   classified   as 
follows : 

Nitrogenous.  Proteins  or  proteids. 


Organic 

(animal  and  vegetable). 


[Hydrocarbons — fats. 


I 

Xon-nitrogenous.  -I  Carbohydrates — sugars 
I     and  starches. 
[Vegetable  acids. 
Inorganic  (Mineral  salts. 

(mineral).  ^^ 

Organic  foodstuffs  are  primarily  divided  into  two  great  classes, 
according  to  the  presence  or  absence  of  the  all-important  element 
nitrogen.  They  consist  of  a  few  constituents,  or  "  proximate  prin- 
ciples," existing  ready  formed  in  nature.  The  three  important 
proximate  principles  entering  into  the  composition  of  all  animal  and 
vegetable  foods  are  the  proteids,  hydrocarbons  and  carbohydrates. 
None  of  these  principles  is  ever  found  alone  in  nature,  but  they  are 
always  associated  in  variable  proportions,  as  in  bread,  meat,  milk 
and  vegetables,  for  man  is  omnivorous  and  needs  them  all  for  his 
best  physical  development.  '(Fig.  65.) 

Nitrogenous  constituents  of  foods.  —  These  constituents,  accord- 
ing to  Prof.  Mallet,  may  be  divided  into  the  following  classes: 

1.  Proteins  proper    (or  albuminoids)    and  their  closely  related 
derivatives,  the  proteoses  and  peptones. 

2.  Gelatinoids  or  collagens   (sometimes  also  called  albuminoids) 
and  allied  substances  immediately  derived  from  them,  such  as  gela- 

3.  Amins,    amino-acids    and    allied    substances,    such    as    "  meat 
bases  "  or  "extractives  "  (creatin,  creatinin,  etc.)  of  animal  origin, 
and  the  asparagin,  glutamin,  etc.,  of  vegetable  substances. 

4.  Alkaloids,  or  amin-like  compounds  of  well-determined  basic 
character,  the  active  principles  of  many  plants. 

307 


308  MILITARY    HYGIENE. 

5.  Ammonia  and  its  salts. 

PROTEIN  (proteos,  first)  is  a  hypothetical  substance  formerly  be- 
lieved to  be  the  essential  nitrogenous  constituent  of  animal  and 
vegetable  foods,  but  now  applied  to  a  number  of  nitrogenous  or 
"  proteid  "  bodies  of  definite  chemical  composition  making  up  the 
bulk  of  the  soft  tissues  and  blood  of  animals,  and  also  widely  dis- 
tributed in  the  vegetable  kingdom.  Protein  and  proteid  are  prac- 
tically synonymous,  although  the  latter  is  more  generally  used  ad- 
jectively.  In  analytic  work  the  term  protein  includes  the  total 
nitrogenous  substance  of  animal  and  vegetable  food  materials,  ex- 
clusive of  the  so-called  nitrogenous  fats.  It  is  employed,  in  com- 
mon usage,  to  designate  the  product  of  the  total  nitrogen  by  the 
factor  6.25,  the  per  centage  of  nitrogen  in  most  proteins  averag- 
ing 16. 

Proteins  form  the  chief  part  of  every  animal  cell,  'being  the  prin- 
cipal constituent  of  muscle,  and  making  up  about  18  per  cent,  by 
weight  of  the  body.  They  are  found  under  many  forms  in  all 
animal  and  vegetable  foodstuffs.  Animal  and  vegetable  proteins 
are  identical  in  chemical  composition  and,  when  equally  digestible, 
have  about  the  same  nutritive  value.  Chemically  they  consist  of 
carbon,  oxygen,  nitrogen,  hydrogen  and  sulphur,  in  the  average  per- 
centages of  52,  23,  16,  7,  0.5  to  2,  respectively.  Phosphorus  is  also 
a  frequent  constituent.  Nitrogen  is  their  characteristic  element. 
All  proteins  are  insoluble  in  alcohol  and  ether,  'but  differ  more  or 
less  as  to  their  solubility  in  water  and  their  decomposition  products. 
Their  solutions  do  not  dialyse,  that  is,  do  not  diffuse  through  animal 
membranes  or  parchment  paper.  Most  of  them  coagulate  when 
heated.  Especially  important  are  the 'two  groups,  albumins  and 
globulins;  the  former,  soluble  in  distilled  water,  are  represented 
chiefly  by  egg  albumin,  serum  albumin  and  lactalbumin  (of  milk)  ; 
the  latter,  insoluble  in  water,  are  re-presented  chiefly  by  egg  globulin 
(vitellin),  serum  globulin,  fibrinogen,  and  myosinogen  (of  muscle). 
Other  noteworthy  proteins  are  the  glutenin  and  gliadin  of  wheat, 
caseinogen  of  milk,  legumin  of  peas  and  beans.  Of  phospho- 
proteins,  that  is,  proteins  with  a  large  proportion  of  phosphorus  in 
their  molecule,  the  most  important  are  the  caseinogen  of  milk  and 
the  vitellins  of  egg-yolk.  Of  compound  proteins,  the  principal  is 
nucleo-protein  (protein  in  combination  with  nuclein)  which  forms 
the  main  constituent"  of  the  nuclei  of  cells.  Nuclein  itself  is  a  pro- 


FOOD.  309 

teid  compound  with  an  organic  acid  (nucleic  acid).  By  digestion, 
proteins  are  transformed  into  the  more  soluble  and  diffusible  pro- 
teoses  and  peptones  which,  by  oxidation  and  the  hydrolytic  action 
of  specific  ferments  (enzimes),  break  up  into  amino-acids  (such  as 
leucin,  tyrosin,  etc.)  with  the  final  end-products  of  carbon  dioxid, 
water  and  urea,  and  small  proportions  of  uric  acid  and  creatinin. 

The  quantity  of  protein  ingested  is  readily  ascertained  from  the 
proportion  contained  in  foodstuffs.  The  amount  discharged  from 
the  body  is  determined  from  the  amount  of  nitrogen  excreted.  It 
is  assumed  that  each  gram  of  nitrogen  corresponds  to  6.25  grams 
of  protein.  It  is  further  assumed  that  meat  contains  an  average  of 
3.4  per  cent,  of  nitrogen  so  that  each  gram  of  nitrogen  corresponds 
to  30  grams  of  muscle.  Nearly  the  entire  quantity  of  nitrogen  ex- 
creted (over  90  per  cent.)  is  found  in  the  urine,  chiefly  as  urea, 
uric  acid,  creatinin,  ammonia  and  amino-bodies.  Creatinin  remains 
practically  constant,  while  creatin,  from  which  it  is  derived,  is  only 
found  in  urine  under  abnormal  conditions,  such  as  starvation  and 
fevers,  indicating  destruction  of  muscular  structure.  Only  about 
one  gram  of  nitrogen  per  diem  occurs  in  the  feces,  made  up  from 
unabsorbed  nitrogenous  bodies  and  others  excreted  from  the  blood. 
Nitrogen,  as  urea,  is  also  found  in  the  sweat,  but  usually  in  such 
small  amount  as  to  be  negligible. 

Among  the  decomposition  products  of  nucleo-protein  is  the  group 
of  purin  bodies.  They  are  substances  chemically  built  around  a 
nucleus  having  the  formula,  C5H4N4,  and  to  which  the  name  purin 
has  been  given.  They  result  from  the  breaking  up  of  nucleo-protein 
into  adenin  and  guanin  (amino-purins)  ;  these  by  oxidation  form 
xanthin  and  hypoxanthin  which,  by  further  oxidation,  yield  the 
terminal  product  uric  acid,  the  chief  form  in  which  the  purins  are 
excreted.  The  meats  richest  in  purins  are  sweetbread,  liver,  beef- 
steak, sirloin,  chicken,  turkey,  veal,  pork  and  mutton.  There  is  no 
difference  between  red  and  white  meats  as  to  their  purin  content. 
This  content  varies  in  fish,  being  low  in  white  fish,  like  cod,  and  as 
high  as  in  meat  in  other  fish,  like  halibut  and  salmon.  Milk  and 
eggs,  as  well  as  vegetables,  are  practically  purin  free. 

The  daily  uric  acid  excretion,  on  an  ordinary  diet,  is  about  one 
gram,  and  does  not  greatly  depend  upon  the  amount  of  nitrogen  in 
food,  being  only  reduced  to  0.6  gram  on  a  purin-free  diet.  A  uric 
acid  diathesis,  however,  is  generally  promptly  improved  by  a  diet 


310 


MILITARY    HYGIENE. 


of  rice,  bread  and  butter.  In  gout,  the  increase  of  uric  acid  in  the 
blood  may  continue  on  a  purin-free  diet,  apparently  the  effect  of  a 
change  into  an  insoluble  form  which  the  kidneys  cannot  excrete. 
Violent  muscular  exercise,  even  on  a  purin-free  diet,  increases  the 
output  of  purin  bases  and  uric  acid,  probably  on  account  of  the 
presence  of  xanthin  and  hypoxanthin  in  muscle. 


tfittrinve  ingre&aito^refuit^aria,  fuel  value. 
/Nutrients.*  yon-nutrients; 

fcroteini    Fats.  I     Carbo-    Mineral  Vater.i    Enfasef 

hydrates,  matters; 


(Calories) 


400      800     1200    1600    2000    2400    2800   3200    3600   40 


FIG.  65. —  Composition  of  the  chief  foodstuffs  entering  into  the  United  States 
Army  ration.     (Atwater.) 

Gelatinoids.  —  Include  ossein,  the  organic  substance  of  bone ;  col- 
lagen, the  chief  constituent  of  white  fibrous  tissue  and  connective 
tissue;  cartilage  and  ligament;  the  air-bladder  and  various  other 
parts  of  fish.  By  'boiling,  these  various  tissues  are  mostly  trans- 
formed into  gelatin  and  chondrin.  Continued  boiling  produces  sol- 
uble gelatin,  gelatoses  and  peptones. 

Organic  extractives.  —  These  are  substances  extracted  from  mus- 
cular and  connective  tissues  by  boiling,  such  as  creatin,  creatinin, 


FOOD.  311 

xanthin,  hypoxanthin  and  allied  cleavage  products  of  the  proteins. 
They  are  soluble  in  water,  of  simpler  constitution  than  the  proteins, 
and  (together  with  certain  mineral  salts,  chiefly  potassium  phos- 
phate) the  most  important  constituents  of  beef^tea  and  many  meat 
extracts.  It  is  to  be  noted  that  flesh  extractives  contain  also  non~ 
nitrogenous  components,  of  which  the  most  important  are  sarcolactic 
acid  and  glycogen. 

It  seems  probable  that  the  xanthin  and  hypoxanthin  of  muscular 
tissue  are  metabolized  into  uric  acid  in  view  of  the  considerable 
increase  of  this  acid  in  the  urine  by  active  exercise. 

HYDROCARBONS  OR  FATS.  —  Fats,  in  nature,  occur  mostly  under 
three  forms,  stearin,  palmitin,  and  olein,  which  are  compounds  of 
glycerin  with  stearic,  palmitic  and  oleic  acids  respectively.  These 
three  compounds  are  always  more  or  less  combined  in  nature. 
Stearin  and  palmitin  are  solid,  while  olein  is  liquid  at  ordinary  tem- 
perature. They  are  free  from  nitrogen,  consisting  chiefly  of 
hydrogen  and  carbon,  with  a  proportion  of  oxygen  too  small  to  com- 
bine with  the  hydrogen  to  form  water,  their  general  formula  being 
C10H18O.  Fat  forms  about  15  per  cent.,  by  weight,  of  the  body  of 
man,  being  mostly  deposited  in  the  abdominal,  muscular  and  sub- 
cutaneous tissues.  All  foodstuffs,  animal  and  vegetable,  contain 
fat  in  variable  proportions ;  especially  rich  in  it  are  meats,  milk,  eggs, 
nuts  and  such  cereals  as  corn  and  oats;  while  some,  like  olive  oil, 
cotton-seed  oil,  butter,  bacon,  suet  and  lard  consist  chiefly  of  it. 

CARBOHYDRATES  are  so  called  because,  in  addition  to  carbon,  they 
contain  hydrogen  and  oxygen  in  proportion  to  form  water,  that  is, 
twice  as  many  atoms  of  hydrogen  as  of  oxygen.  They  occur 
abundantly  in  plants,  chiefly  as  sugars  and  starches,  but  form  less 
than  i  per  cent,  of  the  body  tissues. 

Grape  sugar,  glucose  or  dextrose  (C6H12O6),  the  common  sugar 
of  fruits  and  flowers,  characterized  by  its  property  of  reducing  solu- 
tions of  copper  sulphate,  and  manufactured  on  a  large  scale  by  the 
action  of  dilute  acids  on  starches.  It  is  found  normally  in  animal 
tissues,  generally  from  the  transformation  of  other  carbohydrates, 
or  as  a  morbid  product  excreted  by  the  kidneys,  as  in  diabetes. 

Maltose  is  the  sugar  produced  from  starch  by  the  action  of 
ptyalin  and  amylopsin;  also  produced  by  the  ferment  diastase  in 
germinating  barley,  acting  upon  the  starch  of  the  grain  which  be- 
comes "  malt." 


312  MILITARY    HYGIENE. 

Cane  sugar  or  saccharose  (C12H.22O11~) ,  the  crystalline  sugar  of 
sugar-cane,  beet-root  and  the  sap  of  maple,  birch  and  other  trees. 
It  does  not  reduce  solutions  of  copper  sulphate,  but  is  easily  trans- 
formed into  glucose  'by  fermentation  or  the  action  of  dilute  acids. 

Milk  sugar  or  lactose,  only  found  in  milk. 

Saccharose,  maltose  and  lactose  when  taken  into  the  alimentary 
canal  are  not  utilized  as  such,  but  promptly  converted  into  forms 
of  glucose.  Sugar,  as  glucose  or  dextrose,  is  one  of  the  normal 
constituents  of  the  blood,  its  quantity  being  regulated  by  the  liver 
so  that  a  definite  proportion  is  maintained  in  spite  of  all  fluctuations 
in  the  supply.  This  function  of  the  liver  consists  in  transforming 
the  excess  into  glycogen  or  animal  starch  (C6H10O5)  ;  this  is  stored 
up  as  reserve  material,  chiefly  in  the  liver  and  the  muscles,  to  be 
reconverted  into  sugar  when  needed  by  the  body. 

Saccharin,  a  complex  substance  derived  from  one  of  the  com- 
ponents of  coal-tar  naphtha,  is  a  white,  crystalline  powder,  odor- 
less but  intensely  sweet,  frequently  used  as  a  substitute  for  sugar. 
According  to  an  official  statement  from  the  Department  of  Agricul- 
ture, "the  continued  use  of  saccharin  for  a  long  time  in  quantities 
over  three-tenths  of  a  gram  (4^2  grains)  per  day  is  liable  to  impair 
digestion ;  and  the  addition  of  saccharin  as  a  substitute  for  cane 
sugar  or  other  forms  of  sugar  reduces  the  food  value  of  the  sweet- 
ened product  and  hence  lowers  its  quality." 

Starches  (CGH10O5)  exist  in  all  plants,  being  the  principal  con- 
stituent of  seeds  and  cereals,  as  well  as  many  tubers  and  roots. 
They  are  mostly  derived  from  wheat,  corn,  potatoes,  the  roots  of 
cassava  and  arrowroot,  and  the  pith  of  the  sago-palm.  They  occur 
in  characteristic  granules  made  up  of  concentric  layers,  of  variable 
size  and  shape  according  to  the  plants  producing  them  (Fig.  66). 
Starches  are  insoluble  but,  when  heated  in  water,  the  granules  swell 
up,  burst  their  membranes  and  form  an  easily  digestible  paste. 
With  tincture  of  iodine  they  yield  a  characteristic  intense  blue  color. 
In  the  body  they  are  acted  upon  by  ferments  (enzymes)  and  con- 
verted, at  first  into  a  gum-like  substance  (dextrine),  then  into  dex- 
trose and  glucose. 

Other  carbohydrates  worth  mentioning  are :  cellulose,  which  forms 
the  framework  of  plants  and  constitutes  the  fiber  of  flax,  hemp, 
cotton,  the  hull  of  seeds,  etc.,  being  quite  insoluble  and  of  no  dietetic 
value;  pectin,  which  forms  the  jelly  of  various  ripe  fruits. 


FOOD. 


313 


VEGETABLE  ACIDS  consist  of  the  same  chemical  elements  as  carbo- 
hydrates, but  the  oxygen  is  in  quantity  more  than  sufficient  to  con- 
vert the  hydrogen  into  water.  They  are  derived  from  fruits  and 
other  parts  of  plants.  Those  most  used  as  food  are:  tartaric  acid, 
found  in  grape  juice  as  potassium  tartrate;  citric  acid,  found  in 
the  orange,  lemon  and  other  fruits  of  the  citrus  genus,  as  well  as 


,  rye;  3,  corn; 
buckwheat. 


%-*-*•»-     9    *-f  w  qpur  tAgLT  IS?  ^/ 

\g^ 

FIG.  66. —  Starch  grains  of  various  vegetables,     i,  wheat;  2, 
4.  rice;  5.  horsejbean;  6,  potato;  7.  bean;  8,  pea;  9,  bu 


in  gooseberries  and  potatoes;  malic  acid,  found  in  the  apple  and 
pear;  oxalic  acid,  found  in  rhubarb,  tomatoes,  sorrel  and  other 
plants  with  acid  foliage  ;  acetic  acid,  the  active  constituent  of  vinegar. 
They  exist  in  the  free  state  or,  more  commonly,  in  combination 
as  salts.  In  the  body,  they  are  decomposed  and  become  oxidized 


314  MILITARY    HYGIENE. 

into  carbonates  which  help  to  maintain  the  alkalinity  of  the  blood 
and  other  fluids.  Their  absence  in  foods  is  soon  severely  felt,  re- 
sulting in  a  lowering  of  vitality,  malassimilation  and  symptoms  of 
scurvy. 

MINERAL  SALTS.  —  The  salts  most  necessary  for  the  body  are 
sodium  and  potassium  chlorides,  iron,  and  phosphates  of  lime, 
potassium,  sodium  and  magnesium.  Chlorides  are  indispensable  to 
keep  in  solution  the  globulins  and  albumin  of  the  blood  and  other 
fluids,  as  well  as  to  supply  the  hydrochloric  acid  of  the  gastric  juice. 
The  phosphates  are  needed  for  bone  growth  and  repair,  while  phos- 
phorus is  a  constituent  of  nerve  tissue.  Phosphate  of  lime  is  found 
in  all  tissues  and  seems  essential  to  cell  growth.  Iron  is  a  neces- 
sary constituent  of  the  coloring  matter  of  the  hemoglobin  of  the  red 
blood-corpuscles.  All  these  salts,  with  the  exception  of  sodium 
chloride,  which  is  used  as  a  condiment,  exist  generally  in  sufficient 
quantity  in  drinking  water  and  the  ordinary  articles  of  food. 

NUTRITIVE  FUNCTIONS  OF  FOOD  PRINCIPLES. 

The  proteins  are  the  tissue  formers  and  repairers.  They  form 
the  chemical  basis  of  all  living  cells,  whether  animal  or  vegetable, 
and  are  absolutely  necessary  for  the  building  and  renewal  of  tissues 
and  organs.  No  life  is  possible  without  them.  The  amount  used 
in  the  repair  of  tissues  bears  no  relation  to  the  amount  of  muscular 
work  performed;  it  is  a  daily  constant,  regardless  of  bodily  exer- 
tions. Another  function  of  protein,  but  secondary  and  unimportant, 
is  to  furnish  heat  by  its  combustion  as  fuel.  Under  exceptional 
circumstances  proteins  can  be  converted  into  carbohydrates  as,  for 
instance,  in  the  case  of  diabetic  patients  who  although  fed  on  an 
exclusively  proteid  diet  continue  to  excrete  sugar.  As  much  as  60 
per  cent,  of  the  protein  ingested  can  thus  be  converted  into  sugar. 

Physiologically  two  facts  differentiate  proteins  from  other  food- 
stuffs in  adults:  i,  the  daily  demand  for  them  is  fixed  and  does 
not  vary  with  the  amount  of  work  done  as  is  the  case  with  fats  and 
carbohydrates ;  2,  there  is  no  provision  for  their  storage,  so  that  any 
excess  ingested  must  be  catabolized  and  eliminated. 

An  adult  animal  puts  itself  promptly  into  equilibrium  with  its 
supply  of  nitrogen ;  if  this  supply  be  equal  to  the  needs  of  metabol- 
ism there  is  neither  loss  nor  gain  of  the  body  proteids ;  the  output 
of  nitrogen  is  practically  equal  to  the  intake ;  only  an  evanescent 


FOOD.  315 

gain  of  body  nitrogen  can  be  produced,  in  the  adult,  by  the  most 
liberal  supply  of  proteid  food. 

Bacteria  play  an  important  part  in  the  digestion  and  decomposi- 
tion of  proteins.  The  conditions  necessary  for  their  growth  are 
very  favorable  in  the  intestines  where  they  live  in  symbiosis,  that 
is  to  say,  with  benefit  to  themselves  and  their  host.  .Bacteria  decom- 
pose foodstuffs  and  bring  about  products  often  identical  with  those 
resulting  from  the  action  of  the  digestive  juices,  'but  sometimes  of 
a  different  nature.  In  the  small  intestine  the  carbodydrate  bacteria 
are  the  most  active,  whereas  in  the  large  intestine  they  are  mostly 
replaced  by  those  which  act  upon  protein;  here  their  action  corre- 
sponds to  that  of  trypsin,  but  they  digest  further  and  produce  a 
multitude  of  simple  degradation  products  (ammonia,  fatty  volatile 
acids,  carbon  dioxid,  etc.)  as  well  as  ptomains  and  various  substances 
belonging  to  the  aromatic  series.  These  aromatic  bodies  (which 
also  result  from  the  trypsin  digestion  of  proteins)  are  immediately 
derived  from  certain  amino-bodies,  namely  tyrosin,  tryptophan  and 
phenylamin ;  from  tyrosin  come  phenol  and  its  derivative  kresol, 
while  from  tryptophan  come  indol  and  its  derivative  skatol.  A 
considerable  proportion  of  these  bodies  are  absorbed  into  the  blood 
and  reappear  in  the  urine  as  ethereal  sulphates.  Their  presence  in 
the  urine  has  generally  been  considered  a  convenient  index  of  the 
degree  of  putrefactive  bacterial  action  going  on  in  the  large  intestine. 
To  check,  this  source  of  "auto-intoxication"  which  Metchnikoff 
contends  is  the  chief  cause  of  senility,  the  ingestion  of  lactic-acid- 
producing  organisms  has  been  recommended,  especially  as  found  in 
milk  inoculated  with  Bacillus  bulgaricus  (see  page  342).  Another 
organism,  the  Glycobacter  peptolytictis  of  Metchnikoff  and  Wo  11- 
man,  is  reported,  when  in  the  presence  of  potato  starch,  to  be  another 
preventive  of  the  putrefactive  production  of  phenol  and  indol. 

Gelatinoids  generally  contain  somewhat  more  nitrogen  than  the 
proteins  proper  but,  for  reasons  not  well  understood,  possess  little 
nutritive  value,  the  nitrogen  not  being  in  an  assimilable  form.  Of 
themselves  they  are  incapable  of  keeping  the  body  in  nitrogen 
equilibrium,  but  have  a  rather  marked  protein-sparing  effect  when 
added  to  proteins  in  the  diet,  so  that,  within  certain  limits,  they  may 
act  as  a  substitute ;  thus,  according  to  Kauffmann,  one-fifth  of  the 
protein  ration  can  be  replaced  by  gelatinoids  without  detriment  to 
the  body. 


3l6  MILITARY    HYGIENE. 

Fats  and  carbohydrates  are  the  sources  of  heat  and  energy,  the 
natural  fuel  foodstuffs  of  the  body,  by  their  oxidation  maintaining 
the  body  temperature  and  evolving  power  to  run  the  bodily  ma- 
chinery. The  greater  the  muscular  exertions,  and  the  colder  the 
weather,  the  larger  is  the  amount  needed  and  consumed.  They 
undergo  complete  combustion  in  the  'body  to  simple  gaseous  products, 
namely  carbon  dioxid  and  water.  Fats  containing  much  more  car- 
bon than  carbohydrates  have  a  much  greater  fuel  value  per  pound 
but  are  less  easily  oxidizable.  Like  proteids  they  form  an  essential 
part  of  the  structure  of  tissues,  the  surplus  becoming  stored  in  them 
for  the  needs  of  the  body  economy.  In  the  process  of  digestion  they 
are  mostly  split  by  the  steapsin  of  the  pancreatic  juice  into  fatty 
acids  and  glycerine,  with  formation  of  sodium  soaps;  only  when 
finely  emulsified  are  they  also  split  in  the  stomach  by  the  gastric 
lipase.  After  absorption  of  their  parts,  fats  are  reconstituted  by 
the  action  of  lipase,  a  ferment  thus  shown  to  be  reversible  in  its 
power,  splitting  fats  and  later  bringing  about  their  synthesis,  as 
needed  in  the  tissues.  Bacteria  in  the  intestines  act  upon  fats  like 
steapsin,  but  carry  the  process  a  step  further  down  the  fat-acid 
series. 

Bile  assists  materially  in  the  absorption  of  fat.  When  its  secre- 
tion is  checked  from  any  cause,  there  is  an  excess  of  fatty  acids  in 
the  intestinal  contents,  coating  the  particles  of  food  and  preventing 
the  digestive  juices  from  getting  at  them,  thus  favoring  the  growth 
of  the  bacteria  of  putrefaction. 

Fats  are  specially  concerned  in  the  growth  and  repair  of  brain 
and  nerve  tissues,  forming  one-fifth  of  the  solid  matter  of  the 
brain,  and  are  likewise  of  much  value  in  wasting  diseases  such  as 
tuberculosis.  Much  fat  may  be  derived  from  carbohydrates  as  seen 
by  the  increased  plumpness  of  men  employed  in  sugar  mills,  as  well 
as  by  the  amount  of  cream  in  the  milk  of  cows  simply  fed  on  grass, 
this  amount  being  much  in  excess  of  the  fat  contained  in  the  grass. 
There  is  no  evidence  that  fat  can  be  formed  from  proteins  in  the 
animal  body,  or  that  it  may  'be  converted  into  sugar  in  the  metabol- 
ism of  the  diabetic.  In  fatty  degeneration  there  is  no  change  of 
protein  into  fat,  but  simply  a  wasting  of  the  protein,  so  that  the  fat 
previously  existent  in  the  cells  runs  together  and  comes  prominently 
into  view.  When  not  required  in  the  system,  fats  are  absorbed  with 
difficulty  and  render  many  articles  of  food  indigestible^  or  "  too 


FOOD.  317 

rich."  The  free  use  of  water  seems  to  favor  the  deposit  of  fat  in 
the  body,  while,  on  the  other  hand,  a  diet  consisting  chiefly  of  lean 
meat  causes  rapid  oxidation  of  fat  and  reduces  obesity. 

The  acetone  bodies,  namely  oxybutyric  acid,  diacetic  acid  and 
acetone,  are  largely  derived  from  the  fatty  acids  and  make  their 
appearance  in  the  urine,  when  fats  are  metabolized  at  an  unusually 
rapid  rate,  as  for  instance  in  the  urine  of  diabetes,  starvation  and 
low  carbohydrate  diet.  They  reduce  the  alkalies  of  the  body  and 
produce  the  condition  known  as  acidosis. 

Carbohydrates  are  all  absorbed  as  sugar.  From  the  ready  con- 
version of  sugar  into  fat,  it  does  not  follow  that  these  principles 
are  interchangeable  in  the  diet ;  both  have  doubtless  different  func- 
tions to  perform  before  their  final  reduction  to  carbon  dioxid  and 
water.  Sugar  is  of  special  importance  as  muscle  food,  rendering 
men  capable,  at  least  for  a  few  days,  of  unusual  muscular  exertion, 
and  alleviating  hunger,  thirst  and  fatigue.  When  soldiers  are  called 
upon  to  do  strenuous  work,  nothing  is  better  than  small  cups  of 
black  coffee  strongly  sweetened  with  sugar  or  glucose. 

Experiments  have  shown  that  if  the  supply  of  carbohydrates  be 
deficient  in  the  organism,  creatin  appears  in  the  urine,  with  a  rise 
in  the  output  of  total  nitrogen,  indicating  increased  catabolism  of 
protein,  whereas  if  the  supply  of  carbohydrates  be  abundant,  not 
only  is  there  no  creatin  but  the  required  nitrogen  may  be  lessened 
and  a  normal  equilibrium  obtained  with  from  8  to  10  grams  daily. 

Fat  in  the  food,  even  in  considerable  amount,  does  not  save  protein 
catabolism. 

The  action  of  bacteria  on  carbohydrates  in  the  intestines  is  even 
more  energetic  than  on  proteins.  Besides  doing  all  that  ptyalin  and 
amylopsin  can  do,  they  also  decompose  saccharides  into  simpler 
bodies  such  as  ethyl  alcohol,  lactic  and  butyric  acids.  Without  their 
aid  cellulose  cannot  be  digested  so  that  for  herbivora,  at  least, 
bacteria  are  indispensable. 


CHAPTER  XXV. 
ANIMAL  FOODS. 

For  our  purpose,  animal  foods  may  be  classified  as  follows:  i. 
Meats,  including  poultry  and  game.  2.  Soups  and  meat  extracts. 
3.  Fish,  mollusks  and  crustaceans.  4.  Milk  and  its  derivatives. 
5-  Eggs- 

MEAT. 

Meat  consists  of  muscular  fibers,  connective  tissue  which  holds  the 
fibers  together,  and  fat  cells  in  the  connective  tissue.  Each  fiber  is 
enveloped  and  protected  by  a  sheath  of  sarcolemma,  a  non-contrac- 
tile but  elastic  structureless  membrane,  and  consists  of  many  fibrils 
or  minute,  striated,  microscopic  tubes  whose  contents  continually 
undergo  change  and  renewal. 

The  muscular  fiber  contains  proteins,  salts  and  extractives.  The 
chief  protein  is  myosinogen,  and  the  principal  salt  potassium  phos- 
phate. Extractives  are  nitrogenous  substances  derived  from  pro- 
teins and  "  extracted  "  by  boiling  water ;  they  have  very  little  nutri- 
tive value  but  give  to  meats  their  characteristic  flavors,  increasing 
with  the  age  of  the  animals  and  varying  much  in  quality  according 
to  the  food  of  the  latter;  thus  lamb  and  veal  are  less  flavored  than 
mutton  and  beef,  while  game  animals  feeding  upon  wild  herbs  are 
more  savory  than  domesticated  ones.  The  younger  the  animal  the 
more  watery  is  its  flesh  and  the  lower  its  nutritive  value.  The 
amount  of  fat  in  meat  is  quite  variable,  ranging,  according  to  the 
condition  of  the  animal,  from  3  per  cent,  in  young  fowl,  rabbit  or 
veal  in  which  there  is  no  visible  fat,  to  25  per  cent,  in  fat  steer  and 
90  per  cent,  in  fat  hog;  its  increase  is  always  at  the  expense  of 
water,  the  more  fat  the  less  water  and  conversely. 

According  to  Farrington  (Bureau  of  Animal  Industry),  fat  cattle 
dress  60  per  cent,  of  live  weight,  sheep  50  per  cent.,  hogs  80  per 
cent.  Much  of  the  waste,  however,  could  be  saved  by  better 
methods  and  more  suitable  machinery. 

The  average  composition  of  the  meats  most  used  is  as  follows 
(from  Bulletin  28,  revised  -edition.  U.  S.  Department  of  Agricul- 
ture) : 


ANIMAL    FOODS. 


319 


MEATS. 

Refuse.* 

Water. 

Protein. 

Fat. 

Ash. 

Fuel 
value 
per 
pound. 

BEEF,  FRESH. 

Brisket: 
Edible  portion**  

Per  cent. 

Per  cent. 

54-6 
41.6 

65.0 
54.0 

61.3 
52.9 

60.0 
52.4 

61.9 
54-0 

57.0 
45.3 

67.8 
62.5 

57-9 
46.9 

62.5 
49-5 

62.2 
52.0 

62.2 

50.5 

80.6 

62.6 
53-2 

76.7 
63.1 

71.2 

65.6 

70.9 

90.8 
51-8 

48.2 
63.0 
54-8 

51.8 
51.8 
44-8 
58.9 
51.3 

Per  cent. 
15.8 

12.  0 

19.2 
15.8 

I9.O 
16.4 

21.9 
19.  1 

18.9 
16.5 

17.8 
14.4 

20.  9 
19.2 

18.7 
15-2 

18.3 

14.4 

19-3 
16.1 

18.8 
15-2 

8.8 

16.0 
14.8 

16.6 
13-7 

20.4 

2O.  2 

16.8 

18.9 
14.1 

22.3 
27.6 
23-5 

25-5 
26.3 
39.2 
25  9 
19-5 

Per  cent. 

28.5 
22.3 

15-4 
12.5 

19.  1 
16.9 

20.4 
17.9 

18.5 
16.1 

24.6 
20.  o 

10.6 

9.2 

23-1 
18.6 

18.9 

IS-  1 

18.3 
15.4 

18.8 
15.5 

9-3 

20.4 
24-7 

4.8 
1.9 

4-5 
3-1 

12.1 

9-2 
6.7 

28.6 

7.7 
20.4 

22.5 

18.7 
5-4 
14.8 
23.2 

Per  cent. 

0.9 
.6 

.9 
.7 

I.O 
.9 

I  .0 

.8 

.0 
.9 

.9 

.7 

i  .  i 

I.O 

.9 
.8 

9 

.7 

.9 

.8 

.9 
.7 

1.  1 

I.O 
.9 

.2 
.0 

.6 
.3 
.6 

I.O 

.8 

1.3 
1.8 

I  .2 

1.3 
4.0 
II.  2 
1.3 
4.0 

Cah. 

r.495 
1,165 

1,005 
820 

1,155 
1,020 

1,270 

I  ,  IIO 

1,130 
985 

1.370 

I,  IIO 

835 
745 

i,  32S 

1,065 

1,135 
90S 

1,130 
950 

I.I4S 
935 

555 

i,  1  60 
1,320 

520 
335 

605 
55S 
825 

740 

545 

1,620 
840 
i,30O 

1,425 
1,280 
960 
i,  105 
1,340 

As  purchased*  

23-3 

Chuck,  including  shoulder: 
Edible  portion  

As  purchased  

17.3 

Loin: 
Edible  portion  

As  purchased  

13.3 

Loin,  porterhouse  steak: 
Edible  portion  

As  purchased  

12.7 

Loin,  sirloin  steak: 
Edible  portion  

As  purchased  

12.  8 

Ribs: 
Edible  portion  

As  purchased 

20.  1 

Round: 
Edible  portion  

As  purchased  

8.5 

Rump: 
Edible  poition  

As  purchased  

19.0 

Forequarter: 
Edible  portion  

As  purchased  

20.  6 

Hindquarter: 

16.3 

Sides: 
Edible  portion  

As  purchased  

18.6 

BEEF  ORGANS. 

Heart: 
Edible  portion             

5-9 

Kidney: 
Edible  portion  

As  purchased  

19-9 

Beef  aver: 
Edible  portion  

As  purchased  

7-3 

Sweetbreads,  as  purchased.  .  .  . 

on<*ue: 
Edible  portion  

As  purchased  

26.  S 

BEEF,  COOKED. 

Roast,  as  purchased  

Round   steak,    fat   removed,    as 

Loin  steak,  tenderloin,  broiled, 

BEEF,  CANNED. 

*  Meats,  as  purchased,  always  contain  more  or  less  refuse  (bone,  gristle,  skin,  etc.)  which  lowers 
the  relative  proportion  of  nutrients  . 
**  That  is  to  say,  with  refuse  deducted. 

32° 


MILITARY    HYGIENE. 


MEATS. 


BEEF,  CORNED. 


Corned  beef: 

Edible  portion 

As  purchased 

VEAL,  FRESH. 

Leg,  hind: 

Edible  portion 

As  purchased 1 1 . 7 

Loin: 

Edible  portion 

As  purchased 18 .9 

LAMB,  FRESH. 

Leg,  hind: 

Edible  portion 

As  purchased 13.8 

Loin,  without  kidney  and  tallow: 

Edible  portion 

As  purchased 14.8 

Side,  without  tallow: 

Edible  portion 

As  purchased 19 . 3 

LAMB,  COOKED. 

Leg,  roast 

MUTTON,  FRESH. 

Leg,  hind: 

Edible  portion 

As  purchased 17.7 

Loin,  without  kidney  or  tallow: 

Edible  portion 

As  purchased 

Shoulder: 

Edible  portion 

As  purchased 22 .  i 

Side,  not  including  tallow: 

Edible  portion 

As  purchased 19.3 

MUTTON,  COOKED. 

Mutton,  leg  roast,  edible  portion 

PORK,  FRESH. 

Chuck  ribs  and  shoulder: 

Edible  portion 

As  purchased 18.  i 

Ham,  fresh: 

Edible  portion 

As  purchased 10. 3 

Loin  (chops): 

Edible  portion 

As  purchased 19.3 

Side,  fard  and  other  fat  included: 

Edible  portion 

As  purchased 11.2 


Refuse.         Water. 


Per  cent. 


Per  cent. 


53.6 
4° -2 


71.7 
63-4 

60.5 
56.3 


58.6 
50.3 

53.1 
45-3 

58.2 
47.0 


67.1 


63.2 
5L9 

47.8 
40.4 

6O'.  2 
46.8 

53  6 
43-3 


50.9 


51- 1 
41.8 


SO.i 
45-1 


50.7 
40.8 


29.4 
26.  i 


Protein. 


Per  cent. 


IS. 6 
14-3 


20.7 
18.3 


19.9 
16.1 


18  6 
16.0 


18.7 
16.0 


17.6 
14.1 


18.7 
15.4 


17.5 
13-7 

16.2 
13-0 


25.0 


17.3 
14.1 

15.7 
14-3 

16.4 
13.2 

9-4 
8.3 


Fat. 


Pec  rent. 


26.2 
23.8 


6.7 
5-8 


10.0 

8.2 


22.6 
19.7 

28.3 
24.1 

23.1 

18.7 


17-5 
14-5 

36.2 
31-5 

21.8 
17.1 

29.8 
24.0 


22.6 


31. 1 
25-5 

33-4 
29.7 

32.O 
26.0 

61.7 
54-8 


Ash. 


Per  cent 


4-9 
4-6 


1. 1 
i  .o 


i .  i 
.9 


1.0 
•  9 


.6 


ANIMAL    FOODS. 


321 


MEATS. 

Refuse. 

Water. 

Protein. 

Fat. 

Ash. 

Fuel 
value 
per 
pound. 

PORK,  SALTED  AND  SMOKED. 

Ham,  smoked: 
As  purchased  

Per  cent. 

Per  cent. 
35  8 

Per  cent. 

Per  cent. 

Per  cew/. 

Cols. 

Edible  portion  

39  8 

io  5 

38  8 

Salt  pork,  lean  ends: 

17  6 

7    A 

2,665 

Edible  portion  

19  9 

8   4 

67   i 

2,985 

Bacon,  smoked: 
As  purchased  

8  7 

18  4 

2,685 

Edible  portion  '  

20  2 

io  5 

64  8 

2,930 

CHICKENS. 

Young: 
As  purchased  

18.8 

55  5 

17  8 

7    2 

9 

765 

Edible  portion  

68  4 

21    9 

8  9 

I    i 

945 

Broiler  : 

g 

540 

69  7 

8  3 

890 

Other: 

25    2 

47  3 

910 

Edible  portion  

59-5 

20  4 

19  2 

1  ,350 

OTHER  FOWL. 

Turkey: 
As  purchased  

14  3 

49  2 

19  O 

16  2 

0 

,185 

Edible  portion  

57.4 

22  .2 

18  9 

2 

,385 

57  o 

21    4 

20    6 

I 

,435 

Light  meat  

63.9 

25   7 

9.4 

3 

,065 

Duck: 
As  purchased  

IS-9 

11  .4 

15  4 

16.0 

I 

,085 

Edible  portion  

61.1 

18.3 

19.0 

3 

,290 

Goose: 

II   I 

48  o 

14  8 

25  5 

O 

,475 

Edible  portion  

54.0 

16.6 

28.7 

I 

,660 

Pigeon: 

13  6 

55  2 

19  7 

o  5 

3 

915 

64.0 

22    8 

II    O 

5 

i,  060 

DIGESTIBILITY.  —  The  nutritive  value  of  food  does  not  only 
depend  upon  its  constituents  but  also  upon  its  availability,  that  is, 
the  extent  to  which  it  is  digested  and  absorbed.  Thus  roast  mutton 
and  dried  peas  contain  approximately  the  same  amount  of  protein, 
but  their  nutritive  value  is  very  different.  As  a  rule,  animal  foods 
are  more  digestible  and  completely  absorbed  than  vegetable  foods; 
thus,  of  animal  foods,  97  per  cent,  of  the  proteins,  95  of  the  fats 
and  98  of  the  carbohydrates  are  digested,  while,  of  vegetable  foods, 
only  84  per  cent,  of  the  proteins,  90  of  the  fats  and  97  of  the  carbo- 
hydrates are  digested  (Atzvater),  the  balance  being  discharged  with 
the  intestinal  excreta. 

Rubner  found  that  all  but  3  per  cent,  of  roasted  beef  was  digested 
by  a  healthy  man;  that  flesh  is  more  completely  digested  when 


322  MILITARY    HYGIENE. 

roasted  than  when  either  raw  or  boiled,  and  when  raw  than  when 
boiled. 

Of  the  constituents  of  meat,  the  muscular  fibers  are  most  digestible 
and  most  nutritive.  The  shorter  and  thinner  they  are,  the  more 
tender  the  meat.  The  older  the  animal  the  thicker  the  walls  of  the 
tubes,  the  denser  the  connective  tissue  and  the  less  digestible  the 
meat.  Connective  tissue  is  readily  dissolved  in  the  stomach  but  has 
little  nutritive  value.  A  moderate  amount  of  fat  facilitates  the 
digestion  of  meat ;  more  than  that  hinders  the  action  of  the  gastric 
juice  upon  the  fibers;  therefore,  except  when  much  heat  and  energy 
are  needed,  fat  beyond  a  small  quantity  is  undesirable.  The  di- 
gestibility of  meat  is  also  favored  by  the  amount  of  savory  extract- 
ives which  it  contains,  and  by  the  acids  which  naturally  form  in  it 
as  first  product  of  decomposition;  therefore  it  never  should  be 
eaten  fresh,  but  always  kept  until  it  begins  to  soften,  previous  to 
actual  decay.  This  softening  may  be  produced  more  rapidly  by 
macerating  the  meat  in  weak  vinegar,  or  by  pounding  it  across  the 
cut  ends. 

Mutton  is  drier  than  beef  and  contains  more  fat ;  it  is  a  pleasant 
substitute  for  it  at  times,  but  its  exclusive  or  steady  use  is  not  so 
well  borne.  Pork  differs  from  'both  in  having  less  protein  and  more 
fat,  being  therefore  less  digestible;  somewhat  different  is  bacon  in 
which  the  fat  is  drier,  more  granular  and  generally  accepted  by  deli- 
cate stomachs.  Veal  contains  less  protein  and  more  fat  than  beef 
and  does  not  agree  with  everybody,  while  lamb  differs  but  little 
from  mutton.  The  white  meat  of  poultry  contains  less  fat  than  the 
dark  meat  and  is  more  delicate  and  more  digestible.  Tripe  and 
sweetbreads  are  easily  borne,  but  liver  and  kidneys  require  a  vigor- 
ous digestion. 

Horse  meat  has  a  peculiar  sweetish  flavor  and  is  generally  less 
tender  than  beef,  but,  unless  from  old  or  emaciated  animals,  is  not 
unpalatable  nor  indigestible  and  is  largely  consumed  in  Europe. 
When  well  cooked  it  is  an  excellent  substitute  for  beef  in  emergen- 
cies. Its  fibre  is  coarser  and  of  a  dull  reddish-brown  color.  Horse 
meat  is  distinguished  from  other  meats  by  the  fat,  which  has  a 
lower  melting  point  and  a  higher  iodine  absorption  figure. 

CHARACTERISTICS  OF  GOOD  MEAT. —  For  Army  use  the  only  beef 
accepted  is  from  steers  2  to  6  years  old,  and  occasionally  spayed 
heifers.  The  meat  from  bulls,  stags  (bulls  castrated  late  in  life) 
and  females  (except  spayed  heifers)  is  rejected. 


ANIMAL    FOODS. 


323 


The  lean  of  good  beef  which  has  been  cut  at  least  an  hour  (freshly 
cut  meat  is  always  dark),  should  have  a  bright,  lustrous,  cherry-red 
color,  with  a  distinctly  marbled  appearance  due  to  the  lines  of  fat 
around  the  polygonal  bundles  of  muscular  fibers ;  it  should  be  soft 
and  silky  to  the  touch,  but,  at  the  same  time,  firm  and  elastic,  neither 
pitting  nor  crackling  on  pressure,  the  bright  red  juice  slowly  oozing 
out.  Pale,  moist  muscle  marks  young  sickly  animals,  while  dark, 
tough,  stringy  meat  probably  comes  from  old  ones,  or  perhaps  from 
bull  or  horse.  A  deep,  purple  tint  suggests  that  the  animal  has  died 
from  disease.  The  fat  should  be  reasonably  abundant,  hard  and 
firm;  the  fatter  the  meat,  the  smaller  is  the  proportion  of  protein. 
Good  meat  has  a  slight  but  not  disagreeable  odor.  In  temperate 
climates  the  marrow  of  the  hind  legs  is  still  solid  24  hours  after 
killing,  and  rosy  red.  The  first  evidence  of  decay  is  detected  by 
thrusting  a  wooden  skewer  deep  into  the  flesh,  preferably  alongside 
a  bone,  then  withdrawing  and  smelling  it.  Veal  and  lamb  are  paler 
than  beef  and  softer  to  the  touch.  Mutton  is  of  a  dull  red  color, 
with  very  white  (occasionally  yellowish),  hard  fat  and  no  marbling. 
Pork  is  light  red,  softer  than  beef  or  mutton ;  its  fat  should  be  white 
and  firm. 


FlG.  67. —  Cysticercus  of  pork;  i,  cysts  in  muscle:  2  and  3,  inner  coat  cut  open 
and  parasite  extruded.     (Davaine.) 


MILITARY    HYGIENE. 


DISEASES  OF  CATTLE  AND  HOG.  —  The  diseases  of  cattle  which 
render  their  flesh  more  or  less  unfit  for  food  are  chiefly  pleuro- 
pneumonia,  foot-and-mouth  disease,  Texas  fever,  rinderpest,  an- 
thrax, actinomycosis,  tuberculosis,  pyemia  and  septicemia.  Those  of 
the  hog  are  anthrax,  muco-enteritis,  hog  cholera  and  tuberculosis. 
The  flesh  of  cattle,  sheep  and  hogs  may  also  be  infested  by  various 
parasites.  Some  of  the  diseases  and  parasites  are  transmissible 
to  man. 

MEAT  PARASITES.  —  The  meat  parasites  from  which  man  most 
suffers  are  the  tapeworms  and  trichina  spiralis.  Of  the  several 
species  of  tapeworms,  only  two  are  known  to  infect  man  in  this 
country,  namely  T&nia,  saginata  due  to  measly  beef,  and  Tccnia 
solium  due  to  measly  pork.  In  cattle  and  swine  they  only  exist  in 
the  larval  form  known  as  Cysticercus  bovis  and  C.  cellulose?  (Fig. 
67).  Their  life  history  is  as  follows:  From  the  adult  tapeworm, 
in  the  intestines  of  man,  a  number  of  eggs  are  discharged;  these 
are  expelled  with  the  feces  and  some  find  their  way,  with  water  or 
food,  into  the  digestive  tract  of  cattle  or  swine;  there  the  embryos 


FIG.  68. — .  i,  Trichinae  in  muscle;  2,  embryos;  3,  encysted  trichinae;  4,  cyst 
containing  seven  trichinae ;  5,  trichina  in  fatty  tissue ;  6,  trichina  removed 
from  cyst.  (Laveran.) 


ANIMAL    FOODS.  325 

issue  from  the  eggs  and  piercing  the  intestinal  walls  migrate  to  all 
parts  of  the  body,  where  they  grow  as  "  bladder- worms."  The 
whitish  bladders,  oval  or  elliptic  in  shape,  vary  in  size  from  a  large 
bean  to  a  pin's  head.  The  meat  thus  infested  is  said  to  be 
"  measly ;"  if  eaten  raw  or  imperfectly  cooked,  by  man,  the  cysti- 
cercus  develops  into  the  adult  tapeworm,  thus  completing  the  cycle. 
Bladder-worms  are  readily  killed  by  ordinary  cooking  and  the  meat 
rendered  harmless. 

Trichina  spiralis,  outside  of  man,  is  found  mostly  in  pork,  occa- 
sionally in  other  mammals,  especially  the  rat.  It  is  a  filiform  worm, 
a  millimeter  long,  coiled  within  a  calcareous  capsule  0.2-0.3  mm.  in 
diameter  (Fig.  68).  It  infests  chiefly  the  voluntary  muscles,  being 
more  abundant  near  their  tendinous  extremities,  and  is  generally 
visible  to  the  naked  eye  as  a  small  white  speck,  the  coiled  worm  itself 
being  easily  revealed  under  a  magnifying  glass  after  treatment  in  a 
weak  solution  of  caustic  potash.  Trichinosis  in  hogs  is  but  too  com- 
mon all  over  the  world,  at  least  2  per  cent,  being  thus  affected  in 
this  country.  When  trichinous  pork  is  eaten  raw  or  imperfectly 
cooked,  by  man,  the  capsules  are  dissolved  in  the  stomach  and  the 
worms  liberated ;  in  a  few  days  they  grow  to  full  adult  size  and  the 
females  give  birth  to  numerous  embryos  which  at  once  migrate  to 
all  parts  of  the  body.  This  migration  begins  8  or  10  days  after  the 
ingestion  of  the  infested  meat  and  lasts  about  a  week;  it  is  marked 
by  fever,  puffiness  of  face,  edema  and  intense  muscular  pain.  The 
symptoms  often  suggest  typhoid  fever,  rheumatism  or  acute  tuber- 
culosis. A  characteristic  feature  of  the  blood  is  marked  eosinophilia 
which  gradually  increases  to  55  or  more  per  cent.  An  examination 
of  the  feces  will  reveal  the  embryos.  Death  may  occur  within  a 
few  weeks,  but  generally  the  disease  ends  in  recovery,  the  worms 
becoming  encysted  and  incapable  of  further  injury.  Hogs  are  prob- 
ably infected  by  eating  meat  wastes  or  excrements  from  trichinous 
animals. 

The  incidence  of  trichinosis  in  man  varies  according  to  times  and 
places  but  is  seldom  less  than  i  or  2  per  cent.  Ostler  found  trichinae 
in  5  per  cent,  of  unselected  autopsies  in  Buffalo,  N.  Y. 

The  only  reliable  prophylactic  measure  is  the  thorough  cooking 
of  pork  meat.  The  process  used  in  smoking  and  curing  hams  does 
not  kill  the  parasite ;  they  should  be  boiled  for  several  hours.  While 
the  worms  are  in  the  intestines,  before  their  migration  into  the 


326  MILITARY    HYGIENE. 

muscles,  they  can  be  expelled  by  free  catharsis  and  the  administra- 
tion of  thymol. 

Flukes.  —  Parasitic  flat  worms  found  in  the  liver  of  cattle  and 
sheep,  producing  the  condition  known  as  "  rot."  As  this  disease  is 
very  rarely  conveyed  to  man,  the  flesh  of  animals  thus  affected 
(liver  excepted)  need  not  be  condemned. 

Actinomycosis,  or  "lumpy  jaw"  caused  by  the  presence  of  a 
yellow  ray-fungiis,  occurs  in  cattle  and  swine.  If  care  be  taken  to 
remove  the  involved  parts,  the  meat  may  be  consumed  in  safety. 
It  also  occasionally  occurs  in  man,  apparently  not  from  diseased 
animals  but  from  the  same  unknown  source  that  infested  them. 

TRANSMISSION  OF  DISEASE  BY  MEAT.  —  Of  the  animal  diseases 
transmissible  to  man  the  following  are  noteworthy : 

Tuberculosis,  one  of  the  most  common  diseases  of  cattle,  affect- 
ing also  sheep  and  swine.  In  Europe,  from  10  to  40  per  cent,  of 
cows  are  tuberculous.  In  this  country,  the  percentage  is  not  so 
great,  ranging  from  5  to  30.  The  proportion  of  steers  affected  is 
distinctly  less,  because  they  are  not  so  constantly  stabled,  and  are 
much  younger  when  slaughtered.  It  is  significant  that  at  the 
abattoirs  under  federal  supervision,  in  this  country,  hardly  2  per 
1,000  of  cattle  inspected  are  condemned  for  tuberculosis.  This  may 
be  explained  by  the  facts  that  many  cattle  reacting  to  tuberculin 
show  no  obvious  evidence  of  disease,  and  that  the  majority  of  tuber- 
culous cows  are  slaughtered  by  local  butchers  without  inspection. 
The  number  of  swine  condemned  for  tuberculosis  at  the  abattoirs 
is  more  than  twice  that  of  cattle.  For  diagnostic  purposes  the  use 
of  tuberculin  is  entirely  satisfactory  and  safe ;  a  clear  reaction  to  it 
is  an  unequivocal  assurance  that  the  animal  is  tuberculous.  Safety 
requires  that  it  should  be,  if  not  slaughtered,  at  least  segregated  and 
under  observation.  The  identity  of  human  and  bovine  tuberculosis 
has  been  conclusively  proved,  as  well  as  the  positive  danger,  for 
children,  of  using  milk  from  infected  cows,  especially  when  the 
udder  is  involved.  There  is  also  a  strong  presumption  that  man 
may  become  infected  by  the  meat  of  tuberculous  cattle.  The  organs 
most  frequently  involved  are  the  liver,  lungs,  kidrieys  and  brain  ; 
they  should  always  be  rejected  in  diseased  animals.  The  muscles 
are  very  rarely  affected,  and  whatever  danger  there  might  be  in 
their  consumption  is  completely  removed  by  cooking.  (See  under 
Milk.} 


ANIMAL    FOODS.  327 

Anthrax,  when  occurring  in  cattle,  sheep  and  hogs.  The  meat 
should  be  condemned  and  destroyed,  not  only  because  of  the  diffi- 
culty of  killing  all  the  bacilli  and  spores  by  cooking,  but  also  on 
account  of  the  great  danger  of  infection  through  cuts  and  abrasions. 
The  handling  of  the  hides  is  equally  dangerous  (see  page  100). 

Glanders.  —  There  is  also  danger  of  infection  in  the  handling  of 
the  flesh  and  hide  of  glandered  horses  (see  page  101). 

The  Foot-and-Mouth  Disease  of  cattle  and  sheep,  characterized 
by  a  vesicular  eruption  about  the  mouth  and  feet,  may  be  trans- 
mitted to  man  by  direct  inoculation,  or  the  use  of  milk  of  diseased 
animals,  but  there  is  no  evidence  that  the  meat  is  ever  infected. 

MEAT  POISONING.  —  Bacteria  are  dangerous  not  only  by  their 
toxins  but  also  through  their  proteolytic  action  upon  nitrogenous 
substances  whereby  many  decomposition  products,  harmless  and 
toxic,  are  formed.  These  products,  thus  resulting  from  the  bacterial 
splitting  of  proteid  substances,  have  therefore  nothing  in  common 
with  toxins.  Preeminent  among  them  are  the  ptomains.  These  are 
nitrogenous  bodies,  basic  in  character,  that  is,  able  to  combine  with 
acids  to  form  salts,  and  therefore  analogous  to  the  vegetable  alka- 
loids. A  great  number  of  ptomains  are  known ;  many  are  innocu- 
ous; some  are  highly  toxic  and  to  them  are  attributable  frequent 
cases  of  poisoning  from  the  use  of  infected  meat,  cheese,  ice-cream, 
or  even  vegetables.  The  meats  most  liable  to  be  contaminated  are 
pork  and  veal,  and  their  preparations,  especially  if  used  raw  or 
imperfectly  cooked,  or  containing  part  of  the  entrails  or  viscera. 

Besides  the  harmful  products  of  proteid  decomposition,  meats 
may  be  infected  by  the  toxins  of  various  bacteria,  especially  the  fol- 
lowing : 

Bacillus  botulinus,  large  spore-bearing,  slightly  motile  anaerobe, 
the  cause  of  botulism,  a  dangerous  infection,  chiefly  of  the  nervous 
system,  usually  the  effect  of  the  ingestion  of  tainted  ham,  canned 
meat  or  saus'age.  The  poisoning  of  the  meat  occurs  after  the  death 
of  the  animal ;  it  develops  an  offensive  odor  and  its  unfitness  for 
food  is  gener'ally  apparent  to  the  senses.  The  symptoms  of  botul- 
ism, due  to  a  potent  soluble  toxin  (like  that  of  diphtheria),  are 
chiefly  paralysis  of  the  eye  muscles,  aphonia,  dysphagia,  cardiac  and 
respiratory  distress.  There  is  no  fever  and  consciousness  is  pre- 
served. The  case  mortality  may  reach  25  per  cent  This  bacillus, 
although  spore-bearer,  is  readily  destroyed  by  a  temperature  of  160° 
F. 


328  MILITARY    HYGIENE. 

Bacillus  enteritidis  of  Gartner,  and  allied  bacilli  (forming  the  hog- 
cholera  or  paratyphoid  group)  intermediate  between  the  colon  and 
typhoid  types  and  only  distinguished  from  them  by  some  special 
reactions.  This  bacillus,  when  ingested  with  food  containing  it,  pro- 
duces a  high  fever  and  acute  gastro-intestinal  symptoms.  It  affects 
the  animal  in  life  but,  after  death,  the  flesh  containing  it  does  not 
show  any  visible  sign  of  unwholesomeness.  Its  toxin  (endotoxin) 
is  extremely  resistant  to  heat  and  not  easily  destroyed  by  boiling, 
hence  the  danger  of  meat  contaminated  with  it. 

Bacilli  of  this  group  have  been  isolated  in  cases  resembling  mild 
attacks  of  typhoid  fever  and  called  paratyphoid  (see  page  42). 

B.  proteus  vulgaris,  type  of  a  group  of  the  bacilli  of  putrefaction, 
widely  distributed  and  abundant  wherever  decomposition  takes 
place.  Its  pathogenic  powers  are  feeble,  although  some  outbreaks 
of  meat  poisoning  have  been  attributed  to  it. 

COOKING. 

Cooking  produces  in  foodstuffs  certain  important  physical  and 
chemical  alterations,  affecting  their  quality,  digestibility,  absorption 
and  nutritiousness.  It  often  improves  their  appearance  and,  at  the 
same  time,  develops  new  and  appetizing  flavors.  It  destroys  para- 
sites and  pathogenic  germs,  as  well  as  the  germs  of  putrefaction  and 
those  which  bring  about  the  production  of  ptomains.  Its  effect  upon 
muscular  fibres  is  to  render  them  firmer  and  more  brittle  'by  the 
coagulation  of  albumen,  and  to  separate  them  by  the  softening  or 
gelatinizing  of  the  connective  tissue,  thus  greatly  facilitating  masti- 
cation. It  diminishes  the  amount  of  water  and  removes  more  or  less 
of  the  fat,  salts  and  extractives.  The  digestibility  of  vegetable  food- 
stuffs (some  fruits  excepted)  is  always  much  increased  by  cooking, 
but  that  of  animal  food  may  be  decreased.  Thus  raw  beef  dis- 
appears more  rapidly  from  the  stomach  than  when  boiled ;  experience 
shows  that  raw  or  underdone  meat  is  most  suitable  for  delicate 
stomachs,  provided  it  be  chopped  fine  or  scraped  into  a  pulp  and 
well  seasoned. 

If  meat  is  placed  in  cold  water,  parts  of  the  organic  salts,  the 
soluble  albumen  and  the  extractives  or  flavoring  matters  will  be  dis- 
solved out.  At  the  same  time,  a  small  amount  of  lactic  acid  is 
formed  which  renders  other  parts  of  the  meat  soluble.  The  quantity 
of  materials  dissolved  in  water  depends  upon  the  surface  exposed 


ANIMAL    FOODS.  329 

(the  smaller  the  pieces  the  greater  the  surface),  the  temperature  to 
which  the  water  is  raised  and  time  of  exposure.  If  the  water  be 
heated  gradually,  more  and  more  of  the  soluble  substances  are  dis- 
solved. At  a  temperature  of  about  134°  F.  the  soluble  albumen  will 
begin  to  coagulate,  and  at  160°  will  rise  as  a  brownish  scum  to  the 
top  and  the  liquid  become  clear.  Upon  heating  still  higher,  the 
connective  tissues  begin  to  be  changed  into  gelatin  and  are  partly 
dissolved,  while  the  insoluble  albuminoids  are  coagulated.  The 
longer  the  action  of  the  hot  water  lasts  the  tougher  and  more  taste- 
less the  meat  becomes,  but  the  better  the  broth.  Treated  in  this  way, 
meat  may  lose  over  40  per  cent,  of  its  weight ;  this  loss  is  from  the 
evaporation  of  water,  with  the  exception  of  6  to  10  per  cent,  made 
up  of  fat,  soluble  albumen,  gelatin,  mineral  matters,  organic  acids, 
muscle  sugar  and  flavoring  materials.  The  nearly  tasteless  mass  of 
fibers  left  undissolved  contains  about  all  the  protein  of  the  meat; 
it  has  practically  the  same  nutritive  value  and,  if  properly  com- 
bined with  vegetables  and  the  usual  condiments,  is  almost  as  com- 
pletely digested  as  the  same  weight  of  ordinary  roast. 

All  proteins  coagulate  at  170°  F.  or  less ;  therefore,  in  cooking 
meat,  it  is  unnecessary  to  go  much  beyond  this  point,  except  for  a 
short  time.  The  guiding  rule  in  preparing  animal  and  vegetable 
foods  is  to  cook  them  slowly  and  at  the  lowest  temperature  that  will 
accomplish  the  purpose.  In  cooking  a  piece  of  meat  by  any  method 
(except  when  stewing  or  making  broth),  the  first  step  is  to  subject 
it  to  a  temperature  high  enough  to  speedily  seal  up  the  superficial 
layer  by  the  coagulation  of  its  albumen  and  thus  prevent  the  loss  of 
juice  and  soluble  constituents.  In  boiling,  the  meat  is  plunged  into 
boiling  water  and,  after  a  few  minutes,  the  water  brought  down  to 
about  1 80°,  at  which  temperature  it  is  maintained  at  the  rate  of  15 
minutes  for  each  pound.  If  it  be  desired  to  prepare  broth,  a  dif- 
ferent process  must  be  followed.  In  broiling,  it  is  exposed  to  the 
direct  heat  of  the  fire  which  converts  the  surface  extractives  into 
new,  savory  substances.  In  roasting  (more  properly  baking),  it  is 
placed  in  a  hot  oven,  at  400°  F.,  for  a  few  moments,  and  then  kept  at 
a  much  lower  temperature  at  the  rate  of  15  minutes  per  pound,  tear- 
ing in  mind  that  the  heat  should  be  more  moderate  with  a  large 
joint  than  with  a  small  one,  to  prevent  burning.  Meat  being  a  poor 
conductor  of  heat,  a  large  piece  exposed  to  intense  heat  would  be- 
come burned  outside  long  before  the  heat  could  penetrate  to  the 


33O  MILITARY    HYGIENE. 

interior.  This  is  the  most  popular  and  satisfactory  method  of  cook- 
ing. In  frying,  the  meat,  cut  into  small  pieces,  and  if  desired  rolled 
in  dry  crumbs,  cracker  dust  or  flour,  should  be  dropped  and  com- 
pletely immersed  in  oil  or  fat  heated  to  400°,  or  until  little  jets  of 
steam  issue  from  it;  if  the  temperature  is  not  high  enough,  the 
pores  of  the  meat  not  being  immediately  closed,  it  becomes  impreg- 
nated with  fat  and  indigestible.  Chops  or  fat  meats  are  best  cooked 
by  sauteing,  that  is,  putting  them  in  the  hot  pan  with  just  enough 
fat  to  prevent  sticking,  turning  frequently  and  cooking  quickly. 
In  stewing,  it  is  cut  into  small  pieces  and  placed  in  cold  water  which 
is  heated  slowly  to  180°  where  it  is  maintained  for  several  hours. 
All  the  extractives  and  other  soluble  substances  are  retained  without 
loss. 

Dressed  meat,  as  usually  issued  to  troops,  contains  about  15  per 
cent,  of  bone.  Furthermore,  in  cooking,  it  loses  from  20  to  30  per 
cent,  of  its  weight,  mostly  from  the  evaporation  of  water,  so  that 
the  quantity  consumed  is  reduced  in  weight  to  about  60  per  cent,  of 
the  raw  material.  The  loss  varies  greatly  according  to  the  time  of 
cooking;  thus  with  rare  roasts  the  loss  in  weight  was  found  to  be 
19.48  per  cent  (13.87  water,  5.51  fat,  0.07  nitrogenous  matters  and 
0.03  ash),  while  with  well-done  roasts  it  was  31.29  per  cent.  (17.79 
water,  13.29  fat,  0.15  nitrogenous  matters  and  0.06  ash).  There  is 
greater  economy,  therefore,  as  well  as  improved  digestibility,  in 
stopping  the  cooking  before  the  "  well-done  "  stage  is  reached.  To 
the  meat  proper,  however,  should  be  added  the  value  of  the  juices 
utilized  as  gravy,  broth,  etc.,  and  that  of  the  bones  which  can  be 
used  for  soup. 

Good  cooking  is  deemed  so  important  in  our  Army  that  three 
"  training  schools  for  bakers  and  cooks  "  have  been  established  by 
the  War  Department,  one  at  Washington  Barracks,  D.  C.,  another  at 
Fort  Riley,  Kansas,  and  the  third  at  the  Presidio,  San  Francisco, 
Cal.,  under  the  immediate  charge  of  officers  of  the  Quartermaster 
Corps.  The  classes  under  instruction  are  composed  of  specially 
selected  men  who  manifest  a  desire  to  learn  the  trade  of  baker  or 
cook  and  who  show  aptitude  for  the  work.  The  course  lasts  four 
months  and  covers  the  management  of  messes,  baking  and  cooking 
in  garrison  and  the  field. 


ANIMAL    FOODS.  331 

BROTH,   SOUP  AND  MEAT   EXTRACTS. 

In  preparing  soup  or  broth,  the  object  is  to  dissolve  out  as  much 
of  the  constituents  of  the  meat  as  possible.  The  meat  should  be  cut 
into  small  pieces  and  placed  in  cold  water  which  is  very  slowly  raised 
to  the  boiling  point.  Cracked  bones,  whose  marrow  dissolves  readily, 
are  a  valuable  addition.  In  this  way,  the  broth  will  contain  the 
extractives  and  mineral  matters,  a  small  proportion  of  soluble  pro- 
teids,  a  little  fat  and,  if  the  boiling  be  prolonged,  some  gelatin ;  that 
is  to  say,  all  the  savory  and  appetizing  elements  of  the  meat  but 
hardly  any  of  its  nutritive  principles.  It  stimulates  the  digestive 
functions,  promotes  the  flow  of  gastric  juice  and  prepares  the  way 
for  more  nourishing  food ;  it  is  therefore  a  condiment  and  a  stimu- 
lant. To  make  a  beef-tea  really  nutritious,  the  meat,  after  boiling, 
should  be  dried,  pounded  fine,  screened  and  then  added  to  the  liquid 
extract. 

One  pound  of  beef  meat  and  7  ounces  of  bones  should  make  about 
a  pint  of  strong  broth,  containing  95.2  per  cent,  of  water,  1.2  protein, 
1.5  fat,  1.8  extractives  and  0.3  mineral  matters. 

Good  soup,  that  is  broth  or  "  stock  "  to  which  are  added  vegetables, 
slowly  cooked  and  carefully  skimmed,  is  such  valuable  and  appetiz- 
ing food  that  no  pains  should  be  spared  to  cultivate  the  art  of  mak- 
ing it  and  developing  a  taste  for  it  among  soldiers. 

Meat  extracts  are  obtained  by  the  action  of  boiling  water  upon 
fresh  meat  and  the  concentration  of  the  liquid  by  evaporation. 
They  are  mostly  made  from  the  "  soup  liquor  "  resulting  from  the 
parboiling  of  meat  which  is  to  be  canned.  They  should  be  entirely 
soluble  in  cold  water  and  free  from  albumen,  fat  and  gelatin. 

Meat  juices  are  obtained  from  raw  meats  by  high  pressure  or 
otherwise. 

Inasmuch  as,  in  the  preparation  of  both  extracts  and  juices,  it  is 
necessary  to  bring  them  to  a  certain  temperature  and  remove  the 
greater  part  of  the  coagulable  proteins,  to  prevent  spoiling,  most 
of  their  valuable  nutritive  principles  are  lost.  They  are  useful, 
however,  for  their  stimulating  and  flavoring  qualities.  Beef-tea, 
carefully  prepared  in  the  home  or  hospital,  is,  as  a  rule,  much 
superior  to  commercial  extracts  and  juices. 

PRESERVATION   OF   MEAT. 
As  meat  must  often  be  transported  long  distances,  it  is  necessary 


332  MILITARY    HYGIENE. 

to  make  it  undergo  certain  preparations  whereby  it  may  be  kept  a 
variable  period  of  time  without  decay  or  material  loss  of  nutritive 
qualities.  The  methods  of  preservation  mostly  in  use  are  refrigera- 
tion, canning,  desiccation,  salting  and  smoking. 

Refrigeration.  —  Preservation  by  cold,  whenever  applicable,  is 
generally  preferred.  Cold-storage  houses  are  mostly  cooled  by  the 
ammonia  process,  which  is  based  on  the  property  possessed  by  a 
fluid  of  absorbing  heat  on  passing  from  the  liquid  to  the  gaseous 
form.  Liquid  ammonia,  under  pressure,  is  allowed  to  escape  into 
pipes  where  it  vaporizes  by  absorbing  the  heat  of  contiguous  sur- 
faces. These  pipes  being  coiled  in  a  tank  of  brine,  this  liquid  is 
cooled  below  32°  F.  and  then  pumped  through  the  pipes  used  in 
refrigerating  the  cold-storage  rooms.  The  moisture  of  the  air  con- 
denses on  the  pipes  and  freezes  in  the  form  of  a  dense  coating  of 
frost.  The  gaseous  ammonia,  under  the  combined  effect  of  pressure 
and  cold,  is  again  liquefied  and  then  released,  thus  making  the  pro- 
cess continuous. 

Refrigerated  meat  may  simply  be  chilled  by  exposure  to  a  mini- 
mum temperature  of  25°  F.  or  else  frozen  throughout  at  a  tempera- 
ture of  —  8°  or —  10°  F.  Frozen  meat,  after  being  removed  from 
the  refrigerator,  will  remain  sound  as  long  as  a  week  if  protected 
from  the  sun  and  wrapped  in  non-conductive  material.  Meat 
should  be  kept  frozen  only  when  necessary  for  transportation  and 
trade.  The  Q.  M.  Corps  requires  that  beef  and  mutton  should  be 
frozen  solid  when  delivered  so  that  it  may  not  begin  to  decompose 
before  it  can  be  used.  Otherwise  it  is  best  to  keep  it  just  above  the 
freezing  point,  from  32°  to  40°  F.  At  such  temperature  the  ac- 
tivity of  the  micro-organisms  is  checked  but  the  action  of  the  fer- 
ments normally  present  still  continues,  causing  it  to  "  ripen  "  and 
improve  in  flavor  without  decaying.  Refrigerated  'meat  is  whole- 
some, digestible  and  nutritive ;  it  has  nearly  all  the  qualities  of  fresh 
meat  and,  when  prepared  from  inspected  animals,  is  often  much 
better  than  the  fresh  beef  from  local  markets.  Freezing  causes 
rupture  of  the  muscle  cells,  so  that  in  thawing  there  is  more  or  less 
infiltration  of  the  disintegrated  tissues  and  free  escape  of  the  liquid 
contents,  with  loss  of  weight  and  some  impairment  of  quality. 

Frozen  meat,  when  removed  from  storage,  is  much  more  sensitive 
to  infection  and  liable  to  the  rapid  development  of  deleterious  sub- 
stances than  fresh  meat.  Therefore  it  should  be  placed  in  very  cold 


ANIMAL    FOODS.  333 

water  to  prevent  rapid  thawing  and  further  destruction  of  tissues, 
and  to  permit  the  absorption  of  the  water  lost  during  storage.  It 
should  then  be  consumed  as  soon  as  possible.  The  loss  in  cooking 
is  also  somewhat  greater  than  with  fresh  meat. 

Beef  kept  two  years  in  cold  storage  at  Manila,  P.  I.,  was  found 
"mouldy  outside,  of  dark  color,  dry,  with  fat  turning  yellow."  It 
had  lost  the  aroma  of  fresh  beef  but  retained  a  good  flavor  and  was 
still  of  excellent  quality.  The  loss  in  water  was  7  per  cent. 

The  extent  of  decomposition,  not  appreciable  to  the  senses,  may 
be  determined' according  to  Folin's  methods,  by  the  amount  of  am- 
moniacal  nitrogen  generated,  or  still  better,  by  the  degree  of  acidity 
of  the  fat. 

Poultry.  —  For  cold  storage,  poultry  should  be  dry  picked ;  scald- 
ing (as  practised  for  the  easy  removal  of  feathers)  impairing  the 
integrity  of  the  skin  and  its  resistance  to  bacterial  infection.  It 
should  also  be  dry  chilled  (instead  of  being  cooled  in  water)  in  a 
room  at  35°  or  40°  F.  until  most  of  the  animal  heat  has  been  re- 
moved. Then  it  is  customary  to  freeze  it  at  a  temperature  "below 
zero  and  afterward  to  carry  it  hard  frozen  at  10°  to  15°  F.  until 
used.  If  birds  are  carefully  drawn  (entrails  removed),  they  will 
keep  better  and  longer,  but  as  this  cleaning  process  is  often  care- 
lessly done  and  the  flesh  liable  to  be  contaminated,  most  dealers 
adopt  the  safer  course  of  keeping  them  "  undrawn."  Wild  game 
that  has  been  shot,  therefore  with  intestines  probably  perforated, 
should  always  be  drawn. 

Poultry  is  never  improved  by  cold  storage,  but  its  deterioration 
takes  place  very  slowly.  It  is  only  after  the  sixth  month  that  it 
becomes  notably  shriveled  and  that  a  careful  observer  can  notice 
a  difference  in  the  taste.  Up  to  the  ninth  month  this  difference  is 
very  slight.  Thereafter,  although  the  meat  continues  wholesome, 
there  is  a  loss  of  flavor,  increasing  with  time.  After  removal  from 
cold  storage,  it  should  be  thawed  slowly  in  cool  air,  or  in  the  kitchen 
refrigerator,  rather  than  in  cold  water  which  extracts  a  good  deal 
of  the  flavor  from  the  meat. 

Canning.  —  Next  to  refrigeration,  canning  is  the  best  method  of 
meat  preservation.  Canned  meat  is  largely  used  in  our  service  as 
well  as  in  foreign  armies,  on  account  of  its  very  convenient  shape 
for  transportation  and  distribution. 

Canned  beef  is  usually  from  the  forequarter  of  the  carcass.     It 


334  MILITARY    HYGIENE. 

is  trimmed  so  as  to  remove  as  much  gristle  as  possible  and  the  larger 
pieces  of  fat.  It  is  then  parboiled  about  20  minutes  and  packed  in 
the  cans,  with  the  addition  of  a  little  "  soup  liquor  "  (the  parboil- 
ing liquid),  and  sometimes  a  little  salt  or  molasses.  The  tops  are 
now  soldered  on  and  the  cans  "  processed,"  that  is,  sterilized  by 
heat,  sometimes  in  vacuum  pans,  at  temperatures  ranging  from  216° 
to  250°  F.  according  to  the  process  used;  the  air  is  driven  out 
through  a  puncture  in  the  top,  afterward  closed  with  a  drop  of 
solder.  The  preliminary  parboiling  prevents  any  great  alteration 
in  the  appearance  of  the  muscular  tissue;  it  also  removes  a  large 
quantity  of  water,  thereby  increasing  the  relative  percentage  of  the 
nutritive  constituents;  thus  a  3O-ounce  can  of  roast  beef  contains 
the  equivalent  of  49  ounces  of  fresh  beef,  minus  the  extractives  and 
a  little  fat. 

Canned  meat,  prepared  under  proper  inspection,  is  perfectly 
wholesome ;  the  process  destroys  all  germs  and  parasites  while  pre- 
serving the  nutritive  constituents,  but  melts  the  fat,  gelatinizes  the 
gristle  and  softens  the  muscle  so  that  the  meat  is  less  attractive  to 
the  eye ;  having  lost  some  of  its  extractives  it  is  also  less  savory. 

Bulging,  in  cans,  generally  indicates  decay  and  formation  of 
gases,  the  result  of  a  small  leak  and  access  of  air.  It  may  also  be 
produced  by  freezing  without  detriment  to  the  quality  of  the  con- 
tents, or  by  overstuffing  the  can  with  meat;  in  the  latter  case  the 
swelling  is  on  the  sides,  near  the  top,  and  the  contents  remain  good 
if  the  tin  is  not  broken.  A  leaky  can  placed  in  water  will  show  air 
bubbles.  A  can  may  also  be  concaved  or  collapsed  from  atmos- 
pheric pressure  if  insufficiently  filled. 

All  canned  meats  contain  more  or  less  tin  from  contact  with  the 
can ;  extracts,  more  than  meats  on  account  of  their  acidity.  Lobster 
and  fruits  absorb  relatively  large  quantities  of  it.  Schryver  esti- 
mates that  tin  is  not  harmful  unless  exceeding  20  centigrams  to  the 
kilo  (1,000  grams)  of  contents,  a  proportion  hardly  ever  approxi- 
mated. In  meat  cans  six  years  old,  this  observer  found  only  5  centi- 
grams to  the  kilo. 

The  canned  meats  issued  by  the  Q.  M.  Corps,  all  in  key-opening 
lacquered  cans,  are  corned  beef,  corned-beef  hash,  roast  beef,  roast- 
beef  hash,  beef  and  vegetable  stew. 

Corned  beef  is  from  the  brisket,  chuck  and  plate  of  the  carcass, 
in  two-pound  net  can,  with  not  more  than  i  ounce  of  clear  jelly  from 


ANIMAL    FOODS.  335 

soup  stock.  Chemically  it  contains  51.8  per  cent,  of  water,  26.3 
of  protein  and  18.7  of  fat.  Corned-beef  hash  consists  of  equal 
parts  of  vegetables  (potatoes  and  onions)  and  meat,  suitably  sea- 
soned with  salt  and  pepper.  Roast  beef  is  also  in  two-pound  net 
can,  with  not  more  than  one-half  ounce  of  salt  and  i  ounce  of  clear 
jelly  made  from  soup  stock.  It  contains  about  59  per  cent,  of  water, 
26  of  protein  and  15  of  fat.  Roast-beef  hash  consists  of  equal 
parts  of  vegetables  (potatoes  and  onions)  and  meat,  suitably  sea- 
soned with  salt  and  pepper,  in  28^2-ounce  net  can.  Beef  and  vege- 
table stew  consists  of  iol/2  ounces  of  meat,  7  ounces  of  potatoes,  5 
ounces  of  onion  and  6  ounces  of  sauce,  in  28^-ounce  net  can. 

Salting.  —  With  rare  exceptions,  the  only  salt  meats  issued  in  our 
service  are  bacon  and  corned  beef.  Bacon,  when  properly  cured 
and  smoked,  usually  consists  of  16.8  per  cent,  of  water,  9.2  of  pro- 
tein and  61.8  of  fat.  It  is  appetizing  and  digestible  when  well 
cooked,  and  on  account  of  its  high  calorific  value  particularly  use- 
ful in  cold  countries.  In  warm  countries  it  should  be  eaten  spar- 
ingly, as  a  relish  or  for  a  change  of  diet,  using  the  lean  rather  than 
the  very  fat  and  frying  it  until  crisp  and  crackling. 

Corned  beef  is  prepared  by  pickling  in  a  solution  of  salt,  sugar 
and  saltpeter.  It  contains  about  52  per  cent,  of  water,  26  of  protein 
and  19  of  fat.  As  compared  with  fresh  meat,  it  is  more  nutritive 
but  less  digestible,  tougher  and  much  too  salty  for  prolonged  use. 

Desiccation.  —  This  process  was  formerly  extensively  used  in  the 
West  and  Southwest  or  wherever  the  dryness  of  the  air  permits 
complete  desiccation  of  thin  strips  of  meat  without  putrefaction. 
Meat  thus  prepared,  or  "  jerked,"  retains  all  its  nutritive  qualities. 
Pemmican  consists  of  pounded  jerked  meat,  mixed  with  fat  and 
berries,  to  which  sugar  may  be  added;  it  is  a  rich  food  furnishing 
the  necessary  energy  for  strenuous  work  on  the  frozen  plains  of  the 
Northwest  or  in  the  Arctic  Circle. 

Rapid  Processes.  —  In  emergencies,  when  it  is  desirable  to  pre- 
serve meats  quickly  and  for  a  short  time,  the  fumes  of  sulphur 
(S'CX)  may  be  used;  they  form  a  firm  superficial  protective  layer 
of  alkaline  sulphites  on  the  surface  of  the  meat.  In  this  process 
the  bones  should  be  disarticulated  rather  than  severed.  Formalde- 
hyde has  also  been  found  useful,  as  it  combines  readily  with  the 
albuminous  matters  of  the  surface,  forming  likewise  a  protective 
envelop.  Another  simple  method  recommended  is  to  fire  the  sur- 
face of  the  meat  after  spraying  it  writh  alcohol. 


336  MILITARY    HYGIENE. 

Food  Preservatives.  —  The  antiseptic  substances  employed  for  the 
preservation  of  foods,  but  especially  of  meats,  are  boric  acid  and 
borax,  benzoic  acid  and  benzoate  of  soda,  salicylic  acid  and  salicyl- 
ates,  sodium  sulphite  and  formaldehyde.  There  is  general  agree- 
ment of  opinion  that  the  tendency  of  these  chemicals,  in  daily  doses, 
even  if  very  small,  is  to  injure  the  quality  of  the  food  with  which 
they  are  mixed  and  impair  its  digestibility,  to  disturb  the  metabolic 
functions  of  the  body  and  irritate  the  secretory  and  excretory  or- 
gans. It  is  contended  by  the  U.  S.  Bureau  of  Chemistry  that  there 
is  not  a  single  article  of  food  which  cannot  be  offered  to  the  con- 
sumer in  a  perfectly  sound  and  wholesome  state  without  having  re- 
course to  any  of  these  preservatives,  and  that  their  use  leads  to 
the  neglect  of  the  processes  necessary  to  the  proper  selection,  cleaning 
and  preparation  of  foods.  Borax,  as  well  as  benzoate  of  soda,  are 
frequently  used  in  this  country  and  in  Europe  to  conceal  a  slight 
smell  of  decay  and  neutralize  injurious  products  of  decomposition ; 
such  use  may  be  justified,  under  special  circumstances,  as  the  lesser 
of  two  evils.  According  to  German  experts,  benzoic  acid  (or 
equivalent  of  benzoate)  in  small  doses  amounting  to  0.5  gram  daily, 
is  harmless  to  the  human  body,  but  this  quantity  should  never  be 
exceeded.  It  is  evident  that  the  presence  of  any  of  the  above  pre- 
servatives, in  meat  or  other  food,  will  justify  the  presumption  that 
the  latter  was  not  perfectly  sound  when  prepared,  or  previous  to 
canning  or  refrigeration. 


CHAPTER  XXVI. 

ANIMAL  FOODS  (CONTINUED). 

FISH,  MOLLUSKS  AND  CRUSTACEANS. 

Fish  is  a  wholesome,  nutritious  and  easily  digested  food.  Its 
percentage  of  protein  ranges  widely,  from  15  or  16  as  in  Spanish 
mackerel,  salmon,  halibut,  to  only  8  or  9  in  haddock,  mullet  and 
turbot.  Fish  flesh  contains  more  gelatin-yielding'  material  and  less 
extractive  substances  than  meat.  More  of  its  protein  is  lost  in 
boiling.  It  also  contains  less  fat.  A  few  species,  such  as  salmon, 
turbot,  eels,  mackerel,  lake  trout  and  herring,  contain  10  per  cent. 
or  more  of  fat,  while  the  majority  have  less  than  5  per  cent.  As 
regards  digestibility,  there  is  no  appreciable  difference  between  fish 
and  meat;  in  both,  97  per  cent,  of  protein  and  over  90  of  fat  are 
assimilated.  There  is  very  little,  if  any,  difference  in  thoroughness 
of  digestion  between  fat  and  lean  fish.  The  popular  belief  that 
fish  is  better  brain  food  than  meat  is  without  scientific  foundation 
and  not  proved  by  experience. 

Fish  is  never  improved  by  keeping,  like  meat;  it  decomposes 
quickly  and  should  be  eaten  while  fresh.  It  should  be  considered 
unfit  for  food  when  it  floats  in  water,  when  the  eyes  have  lost  their 
sheen  and  the  cornea  is  somewhat  clouded,  when  the  gills  are  pale 
red,  the  scales  dry  or  easily  loosened,  and  the  meat  dents  on  pressure 
of  the  finger. 

In  cold  storage,  fish  cannot  be  preserved  at  the  freezing  point, 
this  not  being  cold  enough  to  hinder  the  action  of  ferments  and 
production  of  bodies  of  unpleasant  flavor,  although  there  is  no 
decay.  For  fish  previously  frozen,  the  proper  temperature  for 
keeping  is  25°  F.  If  redipped  in  water  now  and  then  so  as  to  re- 
tain a  thin  coating  of  ice  over  the  skin,  it  will  keep  indefinitely. 

Mollusks,  such  as  clams,  oysters  and  mussels,  contain  a  fair  per- 
centage of  proteids  and  a  notable  amount  of  carbohydrates,  but  are 
very  poor  in  fat.  They  are  very  digestible,  oysters  somewhat  more 
so  than  clams  but  less  nutritious.  It  is  estimated  that  one  quart 
of  oysters  (removed  from  the  shell)  contains  about  the  same 
quantity  of  nutritive  substance  as  one  quart  of  milk,  one  pound  of 
bread  or  three-fourths  pound  of  beef.  Good  oysters  and  clams, 
when  removed  from  the  water  close  their  shell,  move  when  touched, 
are  of  normal  size  and  color,  and  the  fluid  inside  the  shell  is  clear. 
Oysters  are  generally  considered  unhealthy  during  the  spawning 

337 


338  MILITARY    HYGIENE. 

season  (June  i  to  Oct.  i),  being  then  bathed  in  a  milky,  viscous 
liquid  containing  innumerable  ova ;  during  this  season  they  also  de- 
teriorate more  rapidly  than  at  any  other  time. 

Before  being  marketed,  oysters  are  generally  "  freshened "  or 
"  floated,"  that  is,  placed  for  2  or  3  days  in  fresh  or  slightly  brack- 
ish water,  where  they  become  plump  and  improve  in  flavor.  This 
plumpness  is  not  a  real  gain  in  flesh  but  simply  the  effect  of  osmosis, 
whereby  water  is  absorbed  and  some  of  the  nutrients  of  the  oyster 
lost. 

Mollusks,  but  especially  oysters,  have  often  been  the  vehicle  of 
typhoid  fever,  and  may,  in  the  same  way,  be  that  of  other  diseases. 
This  happens  when  oyster  or  clam  beds  are  located  near  sewer  out- 
lets or  in  the  way  of  currents  from  infected  places,  or  when  oysters 
are  "  floated "  in  polluted  waters.  Chantemesse  has  found  the 
typhoid  bacillus  in  the  intestine  of  the  oyster,  but  this  is  exceptional 
and  only  the  result  of  great  contamination.  As  a  rule  the  germs  of 
sewage  are  found  only  in  the  water  within  the  shell  or  on  the  surface 
of  the  tissues.  The  standard  recommended  by  the  U.  S.  Bureau  of 
Chemistry  condemns  all  oysters  in  the  shell  which  show  the  presence 
of  Bacillus  coll  types  in  o.i  c.  c.  of  the  shell  liquor,  in  3  out  of  5 
oysters,  this  examination  to  be  supplemented  by  an  inspection  of 
the  beds  and  a  bacterial  examination  of  the  water  in  which  the 
oysters  are  bedded  or  floated.  All  danger  is  removed  by  placing 
the  suspected  oysters  in  pure  sea  water  for  one  or  two  weeks,  by 
washing  them  thoroughly  before  using,  or  else  cooking  them. 

The  liquor  of  shucked  oysters  is  particularly  liable  to  infection 
from  polluted  ice  water  and  unclean  methods  of  handling. 

Oysters  in  cold  storage  should  never  be  frozen.  In  the  shell,  the 
proper  temperature  is  40°  F.,  and  out  of  the  shell  35°. 

Mussels  have  been  observed  to  grow  and  multiply  preferably  in 
sewage-polluted  waters.  Cockles,  on  the  contrary,  generally  keep 
out  of  contaminated  zones. 

Crustaceans,  such  as  lobster,  crab,  crawfish  and  shrimp,  are  richer 
in  proteids  than  mollusks,  but  less  digestible  and  not  suited  to  delicate 
stomachs.  Abalone,  the  ear-shell  of  the  Pacific  Coast,  is  more 
nutritious  than  most  other  sea  products  and  of  excellent  flavor. 
Large  quantities  are  canned. 

The  following  table  (from  Bull.  85,  U.  S.  Department  of  Agri- 
culture) exhibits  the  average  composition  of  the  fish,  mollusks  and 
crustaceans  most  used  as  food  material: 


ANIMAL    FOODS. 


339 


NAME. 

Refuse 
(bone, 
skin, 
etc.). 

Water. 

Protein. 

Fat. 

Carbo- 
hy- 
drates. 

Ash  or 
mineral 
matter. 

Fuel 
value 
per 
pound. 

FRESH  FISH. 

Per  cl. 
46.8 

Per  ct. 

42.  2 

Per  ct. 
10.5 

Per  ct. 

.  2 

Per  ct. 

Per  a. 

7 

Calories. 

56  i 

34  8 

8  7 

2 

6 

168 

51  2 

37  4 

8  8 

2    2 

5 

48.6 

40.3 

IO.O 

.6 

7 

29.9 

58.5 

ii  .  i 

.2 

.8 

209 

9.  2 

72  4 

17.0 

5 

I    O 

327 

Haddock,  dressed  

SI.O 

40.0 

8.4 

.  2 

6 

159 

17   7 

61  9 

15  3 

4   \ 

9 

42.6 

41  .  7 

II  .  2 

3.9 

9 

363 

Mackerel,  dressed  

40.7 

43-7 

II.  6 

3-  S 

.  7 

354 

24   4 

51  4 

16.3 

7-2 

I    2 

585 

Mackerel,  Spanish,  whole.  .  .  . 

34  -6 

44    <> 

14.  i 

6.2 

I    O 

508 

49  o 

38    2 

9  9 

2  4 

6 

277 

57  9 

31   5 

8    2 

2.O 

5 

231 

35-9 

51    2 

12.  O 

.  2 

.  7 

227 

P'ckerel,  whole  

47-  x 

42.2 

9.9 

.  2 

.6 

1  86 

45  5 

39  5 

IO  3 

4-3 

5 

358 

Salmon,  California  (sections)  . 

10.3 

57-9 

16.7 

14.8 

.9 

903 

23  8 

51    2 

15  o 

9  5 

9 

658 

43  9 

39  6 

10.6 

S-4 

.8 

408 

S.OI 

35.  2 

9-  4 

4.8 

.7 

363 

71   2 

23   5 

3.8 

i   5 

581 

Trout  brook,  dressed    

37  9 

48  4 

II  .9 

i  .3 

.7 

268 

Trout,  brook,  whole  

48.  1 

40.4 

9.9 

i  .  i 

.6 

222 

37  5 

44  4 

II    O 

6.2 

7 

44 

39  S 

43   i 

8.9 

8.7 

.8 

513 

47   7 

37  3 

7   7 

7   S 

7 

44  S 

Whitf*fish,  dressed                .    . 

43  6 

39  4 

12    8 

3.6 

9 

376 

53  5 

32  .5 

IO.6 

3.0 

.7 

313 

General  average  of  fresh  fish 

41  6 

44  6 

10.9 

2.4 

.7 

295 

PRESERVED  FISH.** 

19  7 

34  8 

13.9 

21  .2 

2.  I 

1,  107 

24  9 

40  2 

IQ.O 

.4 

I  .2 

363 

Cod!  boneless  codfish,  salted 

54  4 

26.3 

•  3 

1.7 

490 

Herring,  salted,  smoked  and 

<1-1  •'t 

19.  2 

20.  5 

8.8 

•  9 

726 

Haddock,  salted,  smoked  and 

32.2 

49.2 

15.8 

i. 

I.O 

290 

Halibut,  salted,  smoked  and 

7.0 

46.0 

19.3 

14.0 

I  -9 

916 

5.0 

53-6 

23.7 

12.  I 

S3 

916 

14  2 

56.8 

19.5 

7-5 

2.0 

658 

MOLLUSKS. 

Oysters  removed  from  shell.. 

88.3 

6.0 

i  -3 

3-3 

I.  I 

222 

81.4 

16.1 

1.2 

.2 

.7 

•4 

41 

83.4 

8.8 

2.4 

3-9 

i-5 

327 

Round  clams,  rbmoved  from 
shell      

80.8 

10.6 

1.  1 

5-2 

2-3 

331 

67   S 

28.0 

2.1 

.1 

1-4 

.9 

68 

CRUSTACEANS,  ETC. 

61.7 

30.7 

5-9 

.7 

.2 

.8 

141 

77.8 

IS.  I 

1.  1 

.5 

2-S 

38i 

52.4 

36.7 

7.9 

.9 

.6 

1-5 

191 

72.8 

22.2 

•  3 

3-3 

1.4 

501 

75-4 

18  3 

5-2 

.9 

.2 

132 

76  o 

19.2 

4-7 

.1 

•  3 

91 

32.0 

56.9 

10.5 

.  I 

.7 

195 

*  "Dressed"  here  means  prepared  for  market  and,  generally,  ready  for  cooking. 
**  The  percentage  of  salt  is  left  out. 


34O  MILITARY    HYGIENE. 

MILK. 

The  composition  of  cow's  milk  of  average  good  quality  is  as 
follows : 

Fat  (cream),  4.00  per  cent. 

Sugar,  5.00  per  cent. 

Proteins,  3.30  per  cent. 

Mineral  matter,  0.70  per  cent. 


Total  solids,  13.00  per  cent. 

Water,  87.00  per  cent. 

It  differs  from  human  milk  in  containing  twice  as  much  protein 
and  salts,  the  proportion  of  fat  and  sugar  being  about  the  same. 
Therefore  to  make  cow's  milk  of  approximately  the  same  com- 
position as  woman's  milk,  it  is  usual  to  dilute  it  with  an  equal  bulk 
of  water,  and  to  add  cream  and  sugar. 

The  fat  exists  in  very  minute  globules  which,  rising  to  the  surface, 
form  the  creamy  layer.  The  last  part  of  the  milking  ("  strippings  ") 
is  the  richest  in  fat. 

The  proteins  consist  chiefly  of  caseinogen  (2.6  per  cent.)  and 
lactalbumin  (0.7  per  cent.).  Caseinogen,  the  substance  from  which 
casein  is  formed  in  the  presence  of  digestive  ferments,  is  a  phospho- 
protein ;  its  chief  property  is  to  clot  when  treated  with  the  enzime 
rennin  (or  pepsin)  in  presence  of  soluble  calcium  salts,  or  to  curdle 
in  presence  of  acids,  producing  the  curd  of  sour  milk.  The  sugar 
or  lactose  is  much  less  soluble  than  dextrose  or  cane  sugar,  and  less 
sweet ;  through  the  act:  on  of  certain  bacteria  it  changes  into  glucose 
and  then  splits  with  formation  of  lactic  acid,  some  of  the  lactic  acid 
being  further  split  into  butyric  acid.  The  mineral  matter  consists 
of  phosphates  and  chlorides  of  potassium,  sodium,  calcium  and  mag- 
nesium. Potassium  phosphate,  indispensable  for  the  growth  and 
functions  of  muscles,  is  the  most  abundant,  while  calcium  phosphate, 
so  necessary  for  the  growth  and  repair  of  bony  tissues,  comes  next 
in  quantity. 

Milk  is  an  excellent  food  medium  for  bacteria  which,  under 
favorable  conditions,  multiply  in  it  at  the  most  amazing  rate.  Even 
when  the  most  careful  aseptic  precautions  are  taken,  freshly  drawn 
milk  always  contains  bacteria;  these  are  mostly  cocci  and  come 
from  the  udder.  In  a  few  hours,  under  ordinary  exposure,  it  will 
contain  thousands  of  them.  Cleanliness  and  a  temperature  below 


ANIMAL    FOODS.  34! 

50°  F.  will  keep  them  from  rapidly  increasing  for  a  day  or  two,  but 
under  the  ordinary  conditions  obtaining  in  dairies  during  the  sum- 
mer, Harrington  found  them  to  increase  in  24  hours  to  48,000  in  a 
cubic  centimeter,  and  to  680,000  in  48  hours.  Milk,  as  sold  in  city 
stores,  seldom  shows  less  than  100,000  bacteria  to  the  c.  c.,  and  often 
contains  several  millions.  The  effect  of  these  swarming  bacteria 
upon  the  health  of  the  consumer  is  still  a  matter  of  conjecture. 
That  they  modify  the  quality  of  the  milk  and  that  some  of  them  may 
render  it  unwholesome  or  even  poisonous  is  certain.  Several  highly 
toxic  substances,  doubtless  due  to  bacterial  action,  have  been  found 
in  milk,  cheese  and  ice  cream,  such  as  tirotoxicon,  a  crystalline  body 
first  isolated  by  Vaughan,  and  tirotoxin,  similar  to  curare  in  its 
action,  discovered  by  Dakkum,  substances  which  are  the  more 
dangerous  that  they  develop  without  any  apparent  indication  of  their 
presence.  It  is  possible  that  the  summer  diarrhea  of  children  is 
mostly  caused  by  certain  special  pathogenic  bacteria  and  the  poisons 
they  elaborate,  but  the  belief  is  general  that  the  greater  the  number 
of  bacteria  in  milk  the  more  likely  it  is  to  produce  intestinal  disturb- 
ances. Some  cities  have  established  a  maximum  limit  which  must 
not  be  exceeded  in  milk  offered  for  sale.  Boston's  standard  is  500,- 
ooo  bacteria  to  the  c.  c.  Other  cities  have  set  it  as  low  as  100,000. 
For  infant  feeding  it  should  not  be  over  10,000.  It  is  well  to  bear 
in  mind  that  bacteria  in  milk  are  carried  up  to  the  top  layer  with  the 
globules  of  fat,  so  that  their  number  is  much  greater,  nearly  a 
hundredfold,  in  the  cream  than  in  the  milk  below  it.  On  the  other 
hand,  the  bacterial  content  of  separator  cream  (cream  mechanically 
separated)  is  said  to  be  smaller  than  that  of  the  milk  from  which 
it  is  obtained. 

The  infectious  diseases  most  commonly  transmitted  by  milk  are 
tuberculosis  (page  58)  and  typhoid  fever  (page  34),  but  it  may 
also  be  the  vehicle  of  cholera,  dysentery,  diphtheria,  scarlet  fever 
and  septic  sore  throat.  The  bacilli  of  tuberculosis  are  derived  from 
the  cow  itself;  those  of  typhoid  fever,  cholera  and  dysentery  infect 
the  milk  generally  through  the  water  with  which  it  is  diluted  or  the 
dairy  utensils  are  washed.  The  germs  of  the  other  diseases  are 
mostly  derived  from  the  infected  hands  or  uncleanly  habits  of 
milkers  and  others  handling  the  milk. 

When  it  is  considered  that  15  to  20  per  cent,  of  cows  in  the  United 
States  suffer  from  tuberculosis  in  its  various  stages  (as  detected  by 


342  MILITARY    HYGIENE. 

the  tuberculin  test),  and  that  at  least  8  per  cent.  (E.  C.  Schroeder, 
1909)  of  all  samples  of  milk  in  the  market  contain  tubercle  bacilli, 
the  danger  of  human  infection  is  fully  realized. 

Tuberculous  cows  expel  tubercle  bacilli  more  commonly  with 
their  feces  than  in  other  ways.  Even  when  only  slightly  affected, 
they  may  thus  pass  virulent  bacilli.  As  they  do  not  expectorate, 
the  matter  raised  from  the  lungs  is  swallowed  and  the  organisms 
discharged  with  the  contents  of  the  intestines.  Thus  it  happens 
that  milk  is  frequently  infected  through  the  dust  and  manure  of  the 
stable,  especially  while  milking  ungroomed  cows  whose  flanks  are 
incrusted  with  fecal  matter.  Tubercle  bacilli  are  also  expelled 
directly  in  the  milk  when  the  udder  is  affected,  as  well  as  in  ad- 
vanced generalized  tuberculosis.  They  are  likewise  contained  in  the 
matters  slobbered  and  coughed  from  the  cow's  mouth,  and  may  thus 
infect  healthy  cows  eating  off  the  same  box  or  manger. 

The  ingestion  of  raw  milk  is  doubtless  an  important  cause  of 
primary  intestinal  tuberculosis  during  childhood;  at  that  age  the 
bacilli  are  generally  arrested  in  the  mesenteric  glands.  In  adult  life 
they  pass  through  them  much  more  readily,  so  that  pulmonary  tuber- 
culosis is  more  likely  to  develop  without  involvement  of  the  lym- 
phatic glands. 

But  all  bacteria  in  milk  are  not  objectionable;  may  be  regarded 
beneficial  those  which  by  their  action  upon  the  sugar  of  milk  produce 
lactic  acid  and  sour  milk.  Says  Metchnikoff :  "  Among  the  useful 
bacteria,  the  place  of  honor  should  be  reserved  to  the  lactic  bacilli. 
They  produce  lactic  acid  and  thus  prevent  the  development  of  butyric 
and  putrefactive  ferments,  which  are  among  our  dangerous  ene- 
mies." Sour  milk,  in  various  forms,  whether  naturally  or  artificially 
produced,  is  healthful  and,  for  many  stomachs,  a  better  food  than 
sweet  milk.  Metchnikoff  contends  that  senility  in  man  is  chiefly 
due  to  the  action  of  toxic  bacteria  breeding  in  the  large  intestine, 
and  that  lactic  acid,  in  the  shape  of  sour  milk,  is  their  natural  anti- 
dote. He,  accordingly,  recommends  the  use  of  certain  acid-generat- 
ing microbes,  especially  two,  the  "  Bulgarian  bacillus,"  a  powerful 
lactic  acid  ferment  obtained  from  the  Bulgarian  fermented  milk 
"yahourth,"  and  the  "  paralactic  bacillus,"  not  so  strong  hut  im- 
parting to  the  beverage  a  pleasant  flavor.  Skimmed  milk  is  boiled 
a  few  minutes,  then  rapidly  cooled  and  pure  cultures  of  the  above 
bacilli  sown  into  it.  The  result  is  a  sour,,  curdled  milk,  containing 


ANIMAL    FOODS.  343 

about  10  grams  of  lactic  acid  per  litre,  palatable,  slightly  diuretic, 
and  active  in  preventing  intestinal  putrefaction. 

In  the  examination  of  milk,  it  is  necessary  first  to  determine 
whether  water  has  been  added  to  it,  not  only  on  account  of  the 
dilution  it  causes,  but  because  of  the  pathogenic  germs  of  which  it 
is  the  ordinary  vehicle.  Then  a  bacteriological  count  should  be  made 
and  the  sediment  investigated.  Miscroscopic  examination  may  dis- 
close tubercle  bacilli ;  the  typhoid  bacillus  has  been  very  rarely 
detected,  while  the  colon  bacillus  is  very  common  in  milk.  Strepto- 
cocci are  almost  constantly  found  and,  if  numerous,  may  be  of  sus- 
picious origin.  An  excessive  number  of  leucocytes  would  indicate 
disease  of  the  udder.  The  sediment  is  easily  separated  by  straining 
through  a  fine  wire  sieve  or  by  centrifugation.  It  consists  of  hair, 
epithelium,  fecal  matter,  fragments  of  straw,  hay,  etc. ;  in  dirty 
milk  it  is  readily  seen  as  a  collection  of  particles  of  foreign  matter 
at  the  bottom  of  the  bottle. 

Milk  fresh  from  a  healthy  cow,  and  kept  in  clean  vessels  at  a 
temperature  not  exceeding  50°  F.,  is  best  for  all  purposes.  But  the 
average  dairy  milk,  as  supplied  to  the  consumer,  is  far  from  being 
always  fresh,  and  has  generally  been  exposed  to  many  causes  of 
contamination ;  therefore,  to  destroy  the  bacteria  it  may  contain,  it 
should  be  subjected  to  the  action  of  heat,  that  is,  sterilized  or  pas- 
teurized. The  complete  sterilization  of  milk  requires  a  temperature 
of  248°  F.,  but  this  process,  as  well  as  ordinary  boiling,  changes  the 
taste  of  the  milk,  kills  its  natural  ferments  and  probably  otherwise 
impairs  its  nutritive  qualities.  This  impairment,  however,  has  not 
yet  been  satisfactorily  proved ;  it  is  even  contended  by  some  inves- 
tigators that  boiling  causes  the  casein  to  coagulate  in  finer  flakes  in 
the  stomach  and  renders  it  more  digestive.  Nevertheless,  it  is  cer- 
tain that  the  present  tendency  of  sanitarians  is  to  use  no  more  heat 
than  necessary  to  accomplish  the  end  in  view,  which  is  to  kill  all  the 
pathogenic  bacteria  in  the  milk,  a  process  called  pasteurization. 
According  to  Rosenau,  the  heating  of  milk  to  140°  F.,  for  20  min- 
utes, kills  the  micro-organisms  of  tuberculosis,  typhoid  fever,  Malta 
fever,  diphtheria,  cholera,  dysentery,  etc.,  as  well  as  most  bacterial 
toxins,  including  those  of  tetanus  and  botulism.  It  does  not  injuri- 
ously affect  its  taste,  composition,  quality  or  food  value.  The  fer- 
ments remain  intact,  so  that  the  milk  is  in  no  way  devitalized. 

An  objection  urged  against  pasteurization  is  that  it  kills  the  spore- 


344  MILITARY    HYGIENE. 

less  lactic  acid  bacilli  which,  by  souring  the  milk,  tend  to  preserve  it, 
while  the  spore-bearing  peptonizing  bacteria  which  cause  the  decom- 
position and  putrifaction  of  milk  are  less  completely  destroyed.  In 
practice,  however,  it  is  found  that  enough  acid  bacilli  are  left  (or 
added  by  subsequent  handling)  to  sour  the  milk  so  that  the  acid 
development  in  well-pasteurized  milk  is  about  the  same  as  that  in 
clean  raw  milk,  although  somewhat  slower.  Another  objection  to 
pasteurization  is  that  the  bacteria  thereafter  increase  more  rapidly 
than  in  raw  milk,  especially  if  carelessly  handled.  This  happens, 
however,  only  when  the  process  is  imperfectly  carried  out  and  the 
product  riot  properly  chilled. 

There  are  two  methods  of  pasteurization,  the  flash  or  continuous 
method,  in  which  the  milk  is  subjected  to  a  temperature  of  165°  F, 
for  one  minute,  and  the  holder  process,  in  which  -the  milk  is  sub- 
jected to  a  temperature  of  140°  to  150°  for  20  to  40  minutes.  The 
latter  method  is  the  more  reliable  and  should  be  preferred.  Which- 
ever process  is  used,  the  milk  must  be  cooled  at  once  to  a  temperature 
of  45°  or  less  to  prevent  the  rapid  multiplicatoin  of  the  surviving 
bacteria.  The  standard  of  reduction  should  be  99  per  cent,  of  the 
bacterial  content  of  the  raw  milk,  but  the  maximum  count  allowable 
after  pasteurization  should  never  exceed  100,000  to  the  c.  c. 

For  improvised  home  or  hospital  pasteurization,  the  bottles  of 
milk,  after  being  warmed  for  five  minutes,  are  immersed  up  to  the 
lip  in  boiling  water.  The  source  of  heat  being  then  removed  and 
the  receptacle  covered  with  a  lid  or  towel  to  prevent  loss  of  heat, 
the  bottles  are  left  standing  in  the  gradually  cooling  water  for  25 
minutes.  They  are  then  taken  out,  corked  and  quickly  cooled  in  cold 
water  or  ice. 

Dried  or  powdered  milk  is  prepared  by  passing  a  thin  film  of  milk 
over  a  revolving  cylinder  heated  to  about  250°.  It  is  a  coarse, 
granular,  cream-colored  powder,  readily  soluble  in  water.  The  com- 
position of  the  solids  is  but  little  altered  and  their  relative  propor- 
tions remain  the  same.  It  has  the  great  advantage,  when  packed  in 
air-tight  tins,  of  keeping  indefinitely.  Amundsen  used  it  on  his 
journey  to  the  South  Pole  and  speaks  highly  of  it. 

Ice-cream.  —  Standard  ice-cream,  as  defined  by  law,  is  a  frozen 
product  made  from  cream  and  sugar,  with  or  without  a  natural 
flavoring,  and  contains  not  less  than  14  per  cent,  of  milk  fat,  or  not 
less  than  12  per  cent,  when  fruit  and  nuts  are  also  used.  This  defi- 


ANIMAL    FOODS.  345 

nition  excludes  all  substances  commonly  used  as  thickeners,  such  as 
eggs,  gelatin,  starch,  glue,  etc.  Frozen  products  differing  from 
the  standard  are  not  ice-cream  in  a  legal  sense,  and  should  be  desig- 
nated by  suitable  names  descriptive  of  their  composition.  A  striking 
peculiarity  of  commercial  ice-creams  is  their  enormous  bacterial  flora. 
In  1907,  an  examination  of  263  samples  collected  in  the  city  of 
Washington  showed  an  average  of  26,000,000  organisms  per  c.  c. 
Of  these  samples,  71  per  cent,  showed  the  presence  of  gas-producing 
bacteria.  According  to  Pennington  and  Walter,  80  per  cent,  of 
commercial  ice-creams  contain  streptococci.  The  abundance  of  or- 
ganisms in  ice-cream  is  accounted  for  by  the  fact  that  the  great  bulk 
of  milk  bacteria  are  found  in  the  cream  (except  when  mechanically 
separated),  but  it  is  surprising  to  note  the  comparatively  slight  effect 
of  freezing  upon  their  vitality.  Generally  their  number  decreases 
during  the  first  few  days  when  placed  in  cold  storage  (at  about  6° 
F.),  but  nearly  always  increases  afterward.  "  Sometimes  the  killing 
off  of  the  organisms  is  very  slight,  their  number  remaining  almost 
stationary  or  making  a  continuous  upward  curve  "  (G.  W.  Stiles}. 
The  number  and  varieties  of  bacteria  always  found  in  ice-cream, 
and  the  great  ease  with  which  they  multiply  under  conditions  of 
careless  and  uncleanly  manufacture,  explain  the  many  cases  of 
gastrointestinal  disturbances,  as  well  as  the  occasional  cases  of 
acute  poisoning  attributed  to  its  use.  Outbreaks  of  typhoid  fever 
have  been  traced  quite  definitely  to  infected  ice-cream. 

Butter  is  obtained  by  the  churning  of  milk,  and  consists  chiefly 
of  the  fat  (cream),  with  salts,  a  little  casein  and  lactose.  It  is  one 
of  the  most  acceptable  and  digestible  of  fats,  and  the  usual  accom- 
paniment of  our  daily  bread.  It  is  liable  to  infection,  although  the 
presence  of  many  vigorous  saprophytes,  the  washing  out  of  numbers 
of  organisms  into  the  buttermilk,  and  the  salting,  somewhat  lessen 
the  chances  of  pathogenic  bacterial  growth.  When  made  from  in- 
fected milk,  it  may  retain  the  typhoid  bacillus  sixty  days  (Wash- 
burn},  and  the  tubercle  bacillus  4  or  5  months  (Bureau  of  Animal 
Industry).  But  inasmuch  as  butter  is  sterilized  in  cooking,  and 
consumed  otherwise  in  comparatively  small  quantity,  the  danger 
from  its  use  may  not  be  great  but  is  sufficiently  real  to  make  it 
advisable  to  pasteurize  it,  as  well  as  milk ;  it  is  in  no  way  altered 
by  the  process  and,  with  suitable  apparatus,  nearly  as  easily  accom- 
plished. 


346  MILITARY    HYGIENE. 

Oleomargarin,  which  is  made  of  fat,  sour  milk,  dairy  butter  and 
some  vegetable  oil,  is  even  more  liable  to  infection  than  butter, 
because  of  its  several  constituents,  any  of  which  may  be  contam- 
inated, and  the  more  complex  process  of  manufacture,  involving 
more  handling  and  exposure.  It  is  but  little  inferior  to  good  butter 
in  nutritive  qualities. 

Buttermilk,  or  the  milk  from  which  butter  has  been  removed,  has 
still  decided  food  value,  and  its  slight  acidulous  taste  renders  it 
refreshing,  healthful  and  palatable  to  most  persons.  It  shares  the 
bactericidal  properties  attributed  to  sour  milk  by  Metchnikoff. 
There  is  no  doubt,  however,  that  it  can  also  be  infected  by  the 
pathogenic  bacteria  which  may  be  abundantly  contained  in  the  cream 
from  which  it  is  derived.  Therefore  it  should  never  be  used,  as  an 
habitual  beverage,  unless  made  from  pasteurized  milk  or  milk  known 
to  be  reasonably  pure. 

Koumiss,  originally  made  by  the  alcoholic  fermentation  of  mare's 
milk,  is  now  made  from  cow's  milk  by  the  addition  of  cane  sugar  and 
yeast,  which  results  in  the  evolution  of  alcohol  (about  0.76 %}> 
carbon  dioxid  and  lactic  acid.  Kephir,  the  "milk  wine  "  of  some 
Caucasian  tribes,  is  prepared  from  sheep's  and  goat's  milk  with  a 
special  ferment. 

Cheese  consists  essentially  of  the  casein  of  milk.  It  is  made  by 
heating  the  milk  to  above  80°  F.  and  then  curdling  it  by  rennet, 
sour  whey,  or  by  the  acids  formed  by  the  lactic  bacteria.  After 
pressure  to  the  proper  consistence,  the  curd  is  allowed  to  ripen, 
when  are  produced  the  bacteria,  moulds  and  ferments  concerned 
in  the  development  of  special  flavors.  The  composition  of  cheese 
is  variable  according  to  the  milk  used,  and  whether  it  is  whole  or 
skimmed.  American  cheeses  of  good  quality  (tinder  the  names  of 
Cheddar  and  Emmental  or  Swiss  cheeses)  contain  about  36  parts 
of  fat,  30  of  proteins  and  30  of  water.  It  is  therefore  richer  food 
than  meat.  One  pound  has  nearly  the  same  food  value  as  two 
pounds  of  fresh  beef  or  three  pounds  of  fish,  although  costing  only 
about  one-third  more  than  good  beef.  Properly  ripened  cheese, 
with  a  well-developed  flavor,  is  not  only  palatable  and  nutritious 
but  wholesome  and  of  comparatively  easy  digestion.  However,  it 
is  not,  as  a  rule,  as  digestible  as  meat.  For  habitual  use  it  is  only 
suitable  to  laborers  or  men  doing  hard  physical  work.  In  small 
quantity,  the  finer  kinds  make  a  delicious  dessert  on  account  of 
their  savor  and  pungency. 


ANIMAL    FOODS. 


347 


Cheese,  like  other  milk  products,  may  be  infected  by  the  ordinary 
pathogenic  organisms.  Tubercle  bacilli  may  retain  their  virulence 
in  it  for  at  least  two  or  three  months.  But  as  most  cheeses  require 
several  months  for  their  ripening,  they  become  practically  free 
from  infectious  germs  before  they  are  consumed.  Cottage  cheese 
and  other  kinds  which  are  eaten  within  a  much  shorter  time, 
especially  if  "  full  cream,"  may  not  be  above  suspicion  in  that 
regard.  Toxic  bacterial  products  are  sometimes  elaborated  in 
cheese,  causing  acute  poisoning,  as  already  mentioned. 

The  following  table  (from  Bull.  28,  revised  edition,  U.  S.  De- 
partment of  Agriculture)  shows  the  average  composition  of  dairy 
products  and  of  eggs: 


NAME. 

Water. 

Protein. 

Fat. 

Total 
Carbohy- 
drates. 

Ash. 

Fuel 

value  per 
pound. 

Per  cent. 

Per  cent. 

Per  cent. 

Per  cent. 

Per  cent. 

Calories. 

DAIRY  PRODUCTS. 

Milk,      whole,      average      good 

87  o 

3  3 

4  ° 

5  o 

7 

325 

Milk,  condensed,  sweetened.  .  .  . 

26.9 

8.8 

8.3 

54-1 

1.9 

1,520 

Cream,  average  good  quality  .  .  . 

74.0 

2.5 

18.5 

4-5 

•  S 

910 

Butter  

no 

T    O 

85  o 

3.0 

3,605 

Buttermilk  

91  .0 

3.O 

•  5 

4.8 

.7 

165 

31.6 

28  8 

35  9 

3 

3-4 

2,055 

72.0 

20.9 

I    O 

4  3 

1.8 

510 

Cheese   Fromage  de  Erie  

60.2 

15.9 

21  .O 

I  .4 

1  .5 

I,2IO 

50.0 

18   7 

27  4 

I    5 

2.4 

1  ,530 

Cheese  Swiss  

31  .4 

27.6 

34-9 

1  .3 

4.8 

2.OIO 

HEN'S  EGGS.** 

Uncooked,  edible  portion  

73-7 

14.8 

10.5 

i  .0 

72O 

73  2 

14  o 

12    O 

8 

765 

86.2 

13.0 

.  2 

.6 

25O 

Boiled,  yolks  

49.S 

16.1 

33-3 

i  .  i 

I,7O5 

*  The  carbohydrates  are  milk  sugar  and  lactic  acid. 

**  The  refuse,  consisting  of  the  shell,  amounts  to  11.2  per  cent,  of  the  whole  egg. 

Eggs.  —  The  white  and  the  yolk  of  egg  are  of  very  different  com- 
position. The  yolk  contains  a  number  of  substances,  namely:  15 
per  cent,  of  protein  (vitellin),  combined  with  nuclein  and  a  phos- 
phorized  fat  (lecithin)  into  a  body  called  lecithin-nucleo-vitellin ; 
20  per  cent,  of  other  fat  in  emulsion ;  sulphur  and  salts  of  calcium, 
magnesium,  potassium  and  iron.  The  total  phosphorus  is  equivalent 
to  about  i  per  cent,  of  phosphoric  acid.  It  is  mostly  present,  as 
well  as  the  iron,  in  organic  combination  which  renders  their  assimi- 
lation easier  and  more  complete.  The  white  contains  less  protein 
than  the  yolk,  about  twice  as  much  water  and  no  fat. 


348  MILITARY    HYGIENE. 

Eggs  are  among  the  most  quickly  assimilated  foods;  the  yolk, 
especially,  is  most  digestible  and  nourishing,  either  raw  or  soft- 
cooked.  They  are  often  better  borne  than  meat  and  an  excellent 
substitute  for  it,  containing  about  the  same  percentage  of  nutritive 
matter,  that  is,  less  protein  but  more  fat,  both  in  a  very  digestible 
form. 

Eggs  keep  very  well  in  cold  storage  provided  the  temperature  is 
as  low  as  possible  without  freezing  their  contents  to  the  slightest 
extent,  that  is,  ranging  from  28°  to  32°  F.  They  are  as  good  as 
when  put  in  at  the  end  of  6  months.  The  separation  of  the  white 
from  the  yolk  becomes  difficult  after  the  7th  month,  but  the  eggs 
remain  good  to  the  end  of  the  Qth  month  and  sometimes  much  later. 
For  temporary  keeping  or  transportation,  38°  to  40°  is  the  proper 
temperature. 

Fresh  eggs  are  generally  sterile,  but  if  kept  in  insanitary  sur- 
roundings they  soon  become  invaded  (through  the  shell)  by  micro- 
organisms (bacteria,  yeasts  and  moulds)  of  the  most  objectionable 
character;  hence  the  advisability  of  putting  them  promptly  in  cold 
storage. 


CHAPTER  XXVII. 
VEGETABLE  FOODS. 

Vegetable  foods  are  characterized  by  the  large  proportion  of 
carbohydrates  which  they  contain,  especially  starch,  but  they  also 
contain  proteins  and  fats  in  variable  proportions,  thus  furnishing, 
more  completely  than  animal  foods,  all  the  principles  needed  by 
man  for  a  normal  and  sufficient  diet.  In  vegetables  the  nutrients  are 
enclosed  in  cell  walls  composed  of  cellulose  or  woody  fiber  which 
interferes  with  their  digestion,  and  by  irritating  the  intestinal  canal 
increases  peristalsis  and  hastens  the  food  onward  before  there  is 
time  for  absorption.  For  this  reason  the  digestibility  of  vegetable 
foods  is  lower  than  that  of  animal  foods;  thus,  with  cereals,  it  is 
85  per  cent,  for  protein,  90  for  fat  and  98  for  carbohydrates,  while 
for  other  vegetables  the  percentages  seldom  exceed  83,  90  and  95 
respectively.  Cooking  is  necessary  for  the  digestion  of  most  vege- 
tables; it  renders  not  only  starch  but  also  more  or  less  cellulose 
amenable  to  the  action  of  the  digestive  juices. 

The  balance  of  acids  and  bases  in  the  body  is  very  important  for 
the  maintenance  of  a  healthy  physiologic  equilibrium.  Contrary  to 
popular  ideas,  vegetables  and  fruits  show  a  marked  predominance 
of  base-forming  elements.  The  acids  which  they  contain  being 
essentially  organic  in  their  nature  are  wholly  burned  up  in  metab- 
olism so  that,  for  instance,  sodium  citrate,  to  which  are  attributed 
the  antiscorbutic  properties  of  potatoes,  becomes  converted  into 
sodium  carbonate,  and  functions  as  an  alkali.  Meats  and  fish,  on 
the  contrary,  show  a  decided  excess  of  acid- forming  elements ;  this 
excess  is  somewhat  less  in  eggs,  and  much  less  in  cereals.  Milk 
shows  a  slight  predominance  of  bases. 

Vegetable  foods  may  be  classified  as  follows : 

1.  Cereals.  —  Wheat,  rye,  oats,  barley,  rice,  maize. 

2.  Pulses.  —  Beans,  peas,  lentils. 

3.  Tubers  and  roots.  —  Potatoes,  sweet  potatoes,  carrots,  turnips, 
beets,  radishes. 

4.  Green  vegetables.  —  Cabbage,  spinach,  lettuce,  onion,  celery. 

349 


350 


MILITARY    HYGIENE. 


5.  Fruits    used    as    vegetables.  —  Tomato,  aguacate,   cucumber, 
squash,  pumpkin,  egg-plant. 

6.  Fruits.  —  Apple,  pear,  plum,  cherry,  grapes,  peach. 

7.  Nuts.  —  Walnut,  hickory-nut,  chestnut,  peanut,  cocoa-nut. 
The  following  table  shows  the  composition  of  the  vegetable  foods 

most  commonly  used  (from  Bull.  28,  revised  edition,  U.  S.  Depart- 
ment of  Agriculture)  : 


NAME. 

Water. 

Protein. 

Fat. 

Total 
carbohy- 
drates 
(includ- 
ing fiber)  . 

Ash. 

'    Fuel 
value  per 
pound. 

CEREALS  AND  THEIR  PRODUCTS. 

Per  cent. 
ii  0 

Per  cent. 
10  5 

Per  cent. 

Per  cent. 
72    8 

Per  cent. 

2    6 

Calories. 

13  6 

6  4 

Corn  meal,  granular  

12   <; 

9   2 

655 

Hominy  

11.  8 

8  3 

6 

79  O 

,650 

Oatmeal  

7.3 

16.1 

7    2 

67   5 

,860 

12  3 

8  o 

6?o 

Wheat  flour,  average  of  high  and 
medium  grades  

12    O 

II  .4 

I    O 

75   i 

,650 

Wheat  flour,  entire  wheat*.  .... 

ix.  4 

IO  3 

13-8 
13  4 

1.9 

71-9 

"7A    I 

1  .0 

,675 
,665 

35  o 

9   i 

i  6 

1  225 

35   7 

8.9 

I   8 

52     I 

i   5 

,210 

Bread,  corn  (iohnnycake)  
Crackers,  soda  

38.9 
5  -9 

7-9 
9.8 

4-7 
9  .  I 

46-3 

73    i 

2.2 
2     I 

,205 
,925 

S   8 

12    6 

14  o 

66  6 

I    O 

,060 

Malted  milk  

6.0 

12.7 

3  3 

76  2 

i   8 

,795 

VEGETABLES. 

12    6 

22    5 

i   8 

3   5 

605 

18   i 

i   5 

65   9 

4   I 

,625 

pi   5 

I   6 

3 

5  6 

I    O 

145 

Carrots,  edible  part  

oo       , 
oo  .  2 

i  .  i 

I     2 

•  4 

9.3 
5   i 

I.O 

5 

210 

130 

8  4 

25  7 

I    O 

59  2 

S  7 

i  ,620 

88   i 

3   5 

4 

6  8 

I    2 

2IO 

Onions,  edible  part  

87.1 

i  .0 

.  i 

II  .2 

.6 

23O 

9-5 

24.6 

i  .0 

62.0 

2.9 

1,655 

Potatoes,  raw,  edible  part  

78.3 

7    I 

2.2 

8.5 

.1 
•4 

18.4 
80  9 

I.O 

3.  1 

385 
I,  680 

I   8 

7 

27    A 

I   i 

57O 

94-3 

.9 

.4 

3.9 

.5 

1  05 

84  6 

•  4 

5 

14    2 

•  3 

290 

28   I 

1.6 

2    2 

66.1 

2.O 

i,35O 

Prunes,  edible  part  

79.6 

.9 

18.9 

.6 

37O 

Prunes,  dried**  

22  .  1 

2.  I 

73-3 

2.3 

1,400 

75  3 

i  3 

.6 

22    O 

.8 

460 

NUTS. 

5  3 

17  .0 

66  8 

7  o 

3.9 

3,265 

14   I 

5  •  7 

50.6 

27  .9 

i  -7 

2,760 

9.  2 

25.8 

38.6 

24.4 

2.O 

2,560 

2.7 

9.6 

7O.5 

15.3 

I  .9 

3,435 

Walnuts  soft  shell 

2    S 

16.6 

63  .4 

16.1 

I  .4 

3,28s 

Chestnuts,  dried,  edible  part..  .  . 

5.9 

10.7 

7.0 

74-2 

2.2 

1,875 

*  The  ash  consists  almost  entirely  of  potassium  phosphate. 
**  At  least  one  third  of  the  carbohydrates  is  sugar.     Ash  rich  in  potassium  phosphate. 


VEGETABLE    FOODS. 


351 


WHEAT.  —  The  section  of  a  grain  of  wheat  (Fig.  69)  shows  the 
following  parts :  Five  layers  (A,  B,  C,  D,  E)  which  form  the  bran, 
or  about  5  per  cent,  of  the  entire  grain,  the  3  outer  making  up  the 
skin  or  pericarp  and  the  2  inner  the  coats  of  the  seed  proper;  the 
outer  of  these  coats  is  the  testa  which  contains  most  of  the  coloring 
matter  of  the  bran.  Inside  the  seed  coats  is  the  endosperm,  com- 
prising the  aleurone  layer  (F)  made  up  of  large  rectangular  cells, 
and  the  starch  cells  (G).  The  bran  layers  are  mostly  indigestible 
cellulose.  The  aleurone  cells  are  filled  with  nitrogenous  material, 
and  form  about  8  per  cent,  of  the  grain.  The  starch  cells,  more  or 
less  irregular  in  shape,  consist  of  a  wall  of  cellulose,  within  which 


FIG.  69. —  Longitudinal  section  of  grain  of  wheat.  A,  B,  C,  layers  of  skin 
or  pericarp ;  D,  E,  coats  of  the  seed  proper ;  F,  aleurone  layer ;  G,  starch  cells ; 
H,  germ  or  embryo. 


352  MILITARY    HYGIENE. 

is  a  network  of  nitrogenous  protoplasmic  material  thickening 
toward  the  center  into  a  nucleus,  and  containing  proteins,  starch 
granules  and  fat.  The  outer  starch  cells  have  thicker  walls  than 
the  inner  ones  and  are  generally  sifted  out  in  the  making  of  good 
flour.  The  germ  is  rich  in  fat. 

Wheat  flour  varies,  not  only  according  to  the  quality  of  the  grain 
from  which  it  is  made  but  also  according  to  the  method  of  grinding 
the  grain  itself.  The  outer  part  contains  more  of  the  proteins,  fat 
and  mineral  matters  than  the  white  interior  part.  It  follows  that 
the  whitest,  high-grade  flours  are  poorer  in  proteins,  also  slightly 
poorer  in  fat  and  salts,  but  correspondingly  richer  in  starch,  than 
the  low-grade,  colored  flours.  What  they  lose  in  nitrogen  and  other 
constituents,  however,  is  more  than  made  up  by  increased 
digestibility. 

According  to  their  comparative  contents  in  protein  and  starch, 
flours  are  divided  in  three  grades : 

Graham  flour,  from  the  grinding  of  the  entire  grain,  skin  and  all. 

Whole-wheat  flour,  from  the  grinding  of  the  grain  after  removal 
of  the  skin  or  outer  bran  layers. 

Standard  patent  (or  family  grade)  flour,  made  after  removal  of 
the  bran,  aleurone  layer,  outer  starch  cells  and  the  germ.  By  careful 
milling,  73  per  cent,  of  the  grain  can  be  obtained  in  flour  of  this 
quality. 

The  amount  of  protein  is  greatest  in  the  Graham  and  smallest 
in  the  standard  patent  (in  the  proportion  of  12.65  to  11.99),  while 
the  amount  of  carbohydrates  is  smallest  in  the  Graham  and  largest 
in  the  standard  patent  (in  the  proportion  of  74.58  to  75.36).  Care- 
ful experiments  by  the  Department  of  Agriculture  (Farmer's  Bull., 
No.  389)  have  proved  that  the  digestibility  and  assimilation  of 
bread  made  from  standard  patent  flour  is  so  much  greater  than 
that  of  bread  made  from  the  other  grades,  that  it  actually  utilizes 
a  larger  amount  of  both  proteins  and  carbohydrates,  the  proportion 
of  proteins  thus  absorbed  (for  equal  weight  of  milled  grain) 
being  10.62  for  the  standard  patent,  10.05  f°r  the  whole-wheat  and 
9.47  for  the  Graham. 

It  clearly  follows  that  to  eat  Graham  bread  under  the  impression 
that  (the  cost  being  the  same)  it  yields  more  nourishment  than  good 
white  bread,  is  a  groundless  delusion.  Graham  bread  and,  to  a 
lesser  extent,  whole-wheat  bread,  act  as  mild  irritants  to  the  in- 


VEGETABLE    FOODS.  353 

testinal  canal,  increasing  peristalsis  and  producing  a  laxative  effect. 
This  property  may  sometimes  be  useful  in  the  field  where  con- 
stipation often  prevails. 

It  should  also  be  noted  that  wherever  bread  forms  the  great  bulk 
of  the  diet,  whole-wheat  flour  is  preferable  to  the  standard  patent 
on  account  of  the  presence  of  certain  substances  (vitamines)  in  the 
outer  layers  which  are  useful  to  the  nervous  system ;  thus  it  is  well 
known  that  wherever  rice  constitutes  the  main  article  of  diet,  re- 
moval of  its  pericarp  is  likely  to  be  followed  by  symptoms  of 
peripheral  neuritis.  (See  under  Beriberi.) 

Good  flour  should  not  be  of  a  pure  white  color  but  of  a  creamy, 
yellowish  shade.  "After  being  pressed  in  the  hand,  flour  should 
fall  loosely  apart ;  if  it  stays  in  lumps  it  has  too  much  moisture  in 
it ;  when  rubbed  between  the  fingers  it  should  not  feel  too  smooth 
and  powdery  but  its  individual  particles  should  be  vaguely  dis- 
tinguishable ;  when  put  between  the  teeth  it  should  '  crunch  '  a  little ; 
its  taste  should  be  sweet  and  nutty,  without  a  suspicion  of  acidity." 
Flour  is  peculiarly  sensitive  to  the  exhalations  from  other  sub- 
stances and  should  not  be  stored  in  the  same  room  with  decaying 
vegetables  or  articles  that  emit  unsavory  odors.  As  it  deteriorates 
rapidly  when  exposed  to  dampness,  it  should  be  kept  in  dry,  cool, 
well-ventilated  storerooms,  and  in  barrels  rather  than  in  sacks. 
Flour  which  has  fermented  and  become  sour  can  be  partly  corrected 
and  yield  fairly  good  bread  by  the  use  of  good  lime  water. 

The  proteins  of  wheat  consist  chiefly  of  gliadin  and  glutenin 
which,  in  contact  with  water,  form  gluten,  the  tenacious  elastic  sub- 
stance that  gives  consistency  to  the  dough  and  enables  it  to  be 
baked  into  bread.  The  quantity  and  quality  of  these  proteins, 
especially  gliadin,  has  much  to  do  with  the  value  of  the  bread. 

BREAD.  —  There  are  two  general  types  of  bread :  fermented  bread 
when  made  with  yeast,  and  un fermented  bread  when  made  without 
yeast.  Fermented  bread  is  always  preferable.  It  is  generally  made, 
in  post  bakeries,  by  the  sponge-and-dough  process.  In  this  method, 
one-half  the  flour  to  be  used  in  the  baking,  all  of  the  yeast  and  a 
little  more  than  half  the  water,  are  thoroughly  mixed  and  set  aside 
in  an  even  temperature  of  about  80°  F.  to  rise.  This  is  the  sponge. 
When  bubbles  begin  to  break  at  the  surface,  lard,  and  water  in 
which  salt  and  sugar  have  been  dissolved,  are  added  and  the  sponge 
made  into  a  thin  batter.  The  remainder  of  the  flour  is  put  in  and 


254  MILITARY    HYGIENE. 

the  whole  mass  mixed  and  kneaded  into  a  stiff  elastic  dough.     In 
the  straight-dough  process  all  the  ingredients  are  mixed  together 
at  the  same  time.     As  it  saves  time  and  labor  it  should  always  be. 
preferred  in  the  field.     Equally  good  results  can  be  obtained  by 
either  method. 

For  each  100  pounds  of  flour,  about  7  gallons  of  water  will  be 
required,  no  matter  what  process  is  used.  Each  gallon  will  take 
about  3  ounces  each  of  salt,  sugar  and  lard,  and  one  ounce  of 
compressed  yeast. 

Compressed  yeast,  a  pure  culture  of  yeast  with  enough  starch 
to  give  it  body,  is  the  best  kind ;  when  not  procurable  it  is  generally 
replaced  by  a  larger  quantity  of  liquid  yeast  made  either  with  flour 
or  potatoes.  Under  the  influence  of  the  yeast,  another  ferment, 
diastase,  originally  present  in  the  flour,  becomes  active  and 
hydrolyses  some  of  the  starch  into  sugar.  The  yeast  then  acts 
upon  the  sugar,  splitting  it  into  alcohol  and  carbon  dioxid;  the 
latter,  as  it  forms  and  expands,  causes  the  dough  to  "  rise  "  and 
to  become  spongy.  If  the  fermentation  proceeds  too  far,  lactic  and 
butyric  acids  may  form  in  sufficient  quantity  to  make  the  bread 
sour;  if  not  far  enough,  the  bread  will  be  heavy  and  soggy.  Heavy 
bread  may  also  result  from  cheap  flour  poor  in  gluten,  too  much 
water,  too  little  or  poor  yeast,  insufficient  kneading  of  the  dough 
and  imperfect  baking.  The  fermented  dough,  cut  into  loaves,  is 
baked  in  an  oven  heated  to  about  450°  F.  In  this  process,  the 
surface  of  the  dough  is  transformed  into  crust  by  desiccation  and 
partial  caramelization ;  the  gases  expand  still  more  and  the  little 
cavities  are  further  enlarged  by  the  evaporation  of  the  moisture ; 
starch  is  rendered  more  soluble  and  some  of  the  proteids  converted 
into  peptone-like  bodies. 

"A  loaf  of  good,  well-baked  bread  should  be  well  raised  and 
have  a  thin,  flinty  crust  which  is  neither  too  dark  in  color  nor  too 
tough,  but  which  cracks  when  broken.  The  crumb  should  be 
porous,  elastic  and  of  uniform  texture,  without  large  holes,  and 
should  have  a  good  flavor  and  odor."  Bread  should  not  be  eaten 
until  10  or  12  hours  after  its  removal  from  the  oven.  Warm  bread 
is  objectionable  because  readily  compressed  into  solid  masses  offer- 
ing more  resistance  to  the  digestive  juices.  This  objection  has  much 
less  force  against  rolls  or  other  forms  in  which  the  crust  is  very 
large  in  proportion  to  the  crumb. 


VEGETABLE    FOODS.  355 

In  non- fermented  bread,  the  carbon  dioxid  is  generated  by 
"  baking  powders  "  consisting  of  sodium  bicarbonate  and  an  acid 
or  acid  salt,  most  commonly  potassium  bitartate  (cream  of  tartar), 
with  enough  starch  to  prevent  these  ingredients  from  reacting  upon 
each  other  until  dissolved  in  water.  Sometimes  alum  is  used  in- 
stead of  sodium  bicarbonate,  but  the  opinion  is  pretty  general  that 
it  is  an  undesirable  and  harmful  constituent.  Again,  the  baking 
powder  may  be  previously  mixed  with  the  flour  as  in  the  so-called 
self-raising  flour;  or  the  carbon  dioxid  may  be  evolved  in  the  water 
used  to  make  the  dough,  or  otherwise  forced  through  the  latter. 
But  the  bread  resulting  from  any  of  these  artificial  methods  is 
distinctly  inferior  in  taste  and  digestibility  to  fermented  bread. 

In  the  process  of  making  dough,  the  flour  absorbs  50  per  cent, 
of  its  weight  of  water,  one-half  of  which  evaporates  in  the  oven, 
so  that  the  added  weight  is  about  25  per  cent. ;  in  other  words,  100 
pounds  of  flour  should  yield  at  least  125  pounds  of  bread. 

The  typical  high-grade  American  bread,  according  t6  Wiley, 
consists  of :  water  35,  proteins  8,  carbohydrates  54.45,  fat  0.75,  ash 
1.50.  Bread,  therefore,  is  somewhat  deficient  in  proteins,  much 
more  so  in  fats  and  cannot  be  considered  a  perfect  food ;  it  must  be 
supplemented  with  butter,  cheese,  bacon,  or  rich  gravy.  Well-made 
bread  is  highly  nutritious  and  digestible,  the  total  loss  in  the  intes- 
tinal tract  being  less  than  3  per  cent. 

Crackers,  biscuits  and  hard-bread  are  made  from  unleavened  or 
slightly  leavened  dough,  with  as  little  water  as  possible,  and  very 
little  salt,  slowly  and  carefully  baked  and  afterward  kept  for  some 
time  in  a  heated  room  to  complete  desiccation.  As  they  contain 
much  less  water  than  ordinary  bread  they  are  more  nutritious  and 
have  greater  keeping  qualities  but  are  also  less  palatable  and 
digestible. 

The  French  pain  de  guerre,  the  best  hard-bread  yet  baked,  can  be 
kept  sound  and  wholesome  at  least  a  year.  It  is  made  from  an 
excellent  quality  of  flour,  bolted  to  30  per  cent.,  with  yeast  and 
salt,  and  therefore  undergoes  a  certain  degree  of  fermentation 
which  makes  it  more  appetizing  and  absorbent. 

Fresh  soft  bread  is,  under  all  circumstances,  the  best  of  the 
components  of  the  ration  and  should  be  furnished,  even  in  the  field, 
whenever  possible ;  hard-bread  is  but  a  poor  substitute.  Experience 
has  demonstrated  that  baking  bread  in  camp  is  not  attended  with 


356  MILITARY    HYGIENE. 

great  difficulties.  Each  division  in  an  army  should  have  a  baking 
detachment  provided  with  a  sufficient  number  of  portable  ovens, 
which  establishes  itself  at  some  convenient  central  point  in  rear, 
or  divides  into  brigade  sections.  Thus  the  Russian  troops  in 
Manchuria  (1904  and  1905)  were  most  of  the  time  furnished  with 
fresh  bread,  often  baked  only  a  few  miles  from  their  lines. 

Field  bread.  —  A  type  of  fresh  bread  recently  supplied  by  the 
Q.  M.  Corps,  and  of  which  the  constituents  are  issue  flour, 
yeast,  sugar  and  salt.  It  contains  less  water  than  ordinary  bread 
and  is  baked  more  slowly  and  a  longer  time.  It  has  a  thick  crust 
made  to  withstand  handling  and  long  transportation,  and  keeps 
comparatively  fresh  for  a  period  of  from  10  to  14  days,  or  longer, 
depending  upon  weather  conditions.  After  the  crumb  has  become 
hard  and  dry,  through  long  keeping,  it  may  be  freshened  by  wrap- 
ping with  wet  cloths  and  reheating  in  a  very  slow  oven.  That  this 
bread  serves  a  very  useful  purpose  and  is  greatly  appreciated  by 
troops  in  the  field  has  been  demonstrated  during  maneuvers. 

Somewhat  similar  is  the  pain  biscuite  of  the  French,  which  has 
been  exposed  to  prolonged  baking  and  is  drier  than  ordinary  bread. 
It  can  be  kept  for  18  to  20  days  after  issue,  but  has  the  defect  of 
breaking  up  and  crumbling  in  the  haversack. 

MAIZE  OR  CORN,  next  to  wheat,  is  our  most  important  cereal.  It 
is  richer  in  fat  than  any  other  cereal  excepting  oats ;  much  of  this 
fat  is  in  the  germ  which  is  often  removed  to  prevent  the  meal  from 
becoming  rancid  and  mouldy.  On  account  of  its  deficiency  in 
gluten,  corn  cannot  be  made  into  fermented  bread,  but  is  consumed 
under  various  other  forms  and  is  always  nutritious  and  wholesome. 

Parched  corn,  mixed  with  the  pods  of  the  mezquit  tree  (the  seeds 
being  removed)  and  ground  into  a  coarse  flour,  is  the  "pinole" 
of  the  Mexicans,  a  wholesome  and  easily  transported  food  on  long 
journeys. 

OATS  is  the  richest  of  cereals  in  proteins,  fat  and  mineral  matters, 
its  ash  containing  0.42  per  cent,  of  phosphorus.  Oat-meal  is  mostly 
consumed  in  the  form  of  cake  and  as  porridge.  It  is  highly 
nutritious  but  liable  to  produce  acidity  and  disagree  with  some 
persons.  The  large  proportion  of  bran  scales  it  contains  gives  it 
distinct  laxative  qualities.  One  advantage  of  oatmeal  for  soldiers 
in  the  field  is  the  ease  and  quickness  with  which  it  is  prepared;  in 
the  absence  of  fire  it  can  even  be  eaten  raw,  after  soaking  in  water. 


VEGETABLE    FOODS.  357 

RICE  is  the  poorest  of  cereals  in  protein  and  fat,  but  one  of  the 
richest  in  very  digestible  starch.  It  is  the  staple  food  of  about 
one-third  of  the  human  race.  In  the  absence  of  meat,  rice  should 
be  supplemented  with  vegetables  rich  in  proteins,  such  as  beans  and 
peas.  (See  Beriberi.) 

Proper  cooking  is  essential  to  insure  its  palatability  and  digesti- 
bility. It  should  be  sprinkled  into  boiling  water  so  slowly  that  it 
will  not  cool  the  water,  for  a  constant  brisk  ebullition  is  necessary 
to  keep  the  grains  separate  until  cooked. 

Pulses  or  Legumes.  —  Plants  of  the  family  Legummosa,  character- 
ized by  butterfly-shaped  flowers  and  2-valved  seed  pods.  Their 
seeds  are  notable  for  their  richness  in  proteins,  which  equals  or 
often  exceeds  that  of  meat.  They  also  contain  considerable  potash 
and  lime  but  are  poor  in  fat  and  sodium  chloride.  The  chief  pro- 
teins are  legumin  and  glutenin,  forming  what  is  commonly  called 
vegetable  casein.  They  are  highly  nutritious  but  of  more  difficult 
digestion  than  cereals  or  meats ;  under  the  most  favorable  condi- 
tions, from  15  to  20  per  cent,  of  the  proteins  are  unabsorbed  and 
lost.  It  is  therefore  necessary  to  cook  them  thoroughly  and  with 
great  care. 

The  ordinary  pulses  are  beans,  peas  and  lentils.  The  proteins  of 
beans  and  peas  contain  sulphur,  an  ingredient  which  often  gives 
rise  to  flatulency  by  the  formation  of  carbureted  and  sulphureted 
hydrogen.  Dry  beans  and  peas  should  be  soaked  in  warm  water 
for  12  hours  and  then  boiled  several  hours  until  perfectly  done. 
The  water  must  be  soft,  for  the  legumin  forms  insoluble  com- 
pounds with  lime;  if  hard,  it  should  be  previously  boiled  to  pre- 
cipitate the  carbonates,  or  else  have  sodium  carbonate  added  to  it. 
Peas  are  best  used  ground,  as  meal,  making  palatable  and  very 
nourishing  soup;  they  are  a  good  occasional  substitute  for  beans. 
The  pea-sausage  of  the  German  Army  consists  of  pea  flour,  fat 
pork  and  salt;  it  is  a  good  emergency  food,  being  issued  cooked, 
and  readily  made  into  soup.  Lentils  are  the  best  of  the  pulses  and 
deserve  to  be  better  known  and  more  generally  used  in  this  country. 
They  contain  even  more  proteins  than  beans  and  peas,  and  are  free 
from  sulphur;  they  are  more  digestible,  more  easily  cooked  and 
fully  as  well  flavored. 

The  cow-pea,  much  cultivated  in  the  Southern  States  as  forage 
plant  and  green  manure,  also  belongs  to  this  family.  Some  varieties 


358 


MILITARY    HYGIENE. 


are  as  good  as  beans  in  regard  to  nutritive  value,  digestibility  and 
flavor. 

The  Soy  Bean  (Glycina  hispida)  is  the  most  important  pulse  of 
China  and  Japan,  being  remarkable  for  its  high  percentage  of  pro- 
tein (34)  and  fat  (17).  It  is  manufactured  into  a  number  of 
products,  all  rich  in  protein  and,  when  combined  with  rice  (the 
staple  food  of  those  countries),  helping  to  make  a  well-balanced 
dietary.  The  best  known  are  shoyu  or  soy  sauce,  a  thick  brown 
liquid  with  pungent,  agreeable  taste,  and  several  kinds  of  .cheese-like 
preparations.  They  contain  little  or  no  starch  and,  on  this  account, 
have  been  recommended  for  diabetics. 

Tubers. — Tubers  are  underground 
stems  thickened  into  oblong  or 
rounded  bodies  bearing  "  eyes  "  or 
buds.  The  only  true  tubers  com- 
monly used  as  food  are  the  potato 
and  the  Jerusalem  artichoke. 

Potato  is  a  wholesome  and  easily 
digested  food  but,  on  account  of  its 
very  small  content  of  proteids  and 
fats,  an  imperfect  one. 

If  a  cross  section  of  a  raw  potato 
(Fig.  70)  is  held  up  to  the  light, 
four  distinct  zones  can  be  seen :  the 
skin;  the  cortical  layer,  slightly  col- 
ored and  denser  than  the  inner 
parts ;  the  outer  and  inner  medul- 
lary areas.  The  skin  and  cortical  layer  make  up  about  n  per 
cent.,  and  the  medullary  areas  89  per  cent,  of  the  tuber.  The 
outer  medullary  area  contains  the  greater  part  of  the  nutrients.  The 
inner  area,  or  somewhat  star-shaped  core,  spreads  irregular  arms 
into  the  outer.  When  this  core  is  large  it  makes  a  soggy  mass,  full 
of  holes  after  cooking.  In  peeling  a  raw  potato,  the  loss  in  weight 
is  about  20  per  cent.,  namely  the  skin,  most  of  the  cortical  layer, 
and  more  or  less  of  the  medullary  areas ;  in  reality  the  loss  of 
nutrients  is  even  greater  than  this  would  seem  to  indicate  owing 
to  the  larger  proportion  of  proteins  and  mineral  matters  existing  in 
the  outer  layers.  It  is  best  therefore  to  remove  the  skin  mechan- 
ically, by  scraping,  rather  than  by  cutting. 


FIG.  70. —  Transverse  section  of 
the  potato ;  a,  skin ;  b,  cortical 
layer;  c,  outer  medullary  layer; 
d,  inner  medullary  area. 


VEGETABLE    FOODS. 


359 


The  most  important  mineral  matters  in  the  potato  are  potash  and 
phosphoric  acid  compounds;  it  also  contains  citric,  tartaric  and 
succinic  acids,  forming  salts  with  potash,  soda  and  magnesia  to 
which  are  due  its  well-known  antiscorbutic  properties. 

In  the  process  of  boiling  a  potato,  more  or  less  protein  and  mineral 
matter  are  lost;  comparatively  little  if  boiled  with  the  skin,  but  a 
great  deal  if  it  has  been  peeled,  amounting  to  nearly  one-half  if, 
besides,  it  has  been  soaked  in  water.  If  peeled  before  cooking  it 
should  be  placed  directly  in  hot  water.  Potatoes  cooked  with 
jackets  on  are  more  nutritive  and  palatable  than  if  peeled;  a  section 
of  skin  should  first  be  removed  at  each  end  so  that  the  moisture 
may  escape.  They  should  be  slowly  boiled  for  30  minutes.  If 
cooked  rapidly  or  too  long  they  become  soggy.  Mealiness  is  highly 
desirable  in  a  cooked  potato,  on  account  of  its  increased  palatability, 
but  waxiness  is  probably  an  indication  of  greater  quality,  being  due 
to  a  higher  proportion  of  protein,  as  often  seen  in  young  tubers. 

Normally  the  potato  contains 
only  traces  (mostly  in  the  skin) 
of  the  narcotic  poison,  solanin, 
which  exists  more  abundantly  in 
many  of  the  other  plants  of  the 
same  family  (Solanacecr) .  Un- 
der certain  conditions,  however, 
the  amount  of  this  poison  in  the 
potato  increases  to  the  extent  of 
becoming  dangerous ;  this  may 
occur  in  potatoes  that  are  young 
and  immature,  mouldy  or  de- 
cayed, and  always  when  sprout- 
ing. Therefore,  to  be  whole- 
some, potatoes  should  be  fairly 
well  grown,  sound  and  without 
any  sign  of  sprouting  buds. 

Jerusalem  artichoke,  a  tuberous  perennial  sunflower,  growing  wild 
in  the  middle  western  United  States,  is  more  or  less  cultivated  in 
this  country  and  Europe.  The  small,  knobby  tubers  contain  15  per 
cent,  of  carbohydrates,  mostly  in  the  shape  of  inulin  and  levulin 
instead  of  starch.  They  are  wholesome,  digestible,  palatable,  and 
often  used  in  salad.  An  easily  grown  and  very  prolific  plant. 


FIG.  71. — Cells  of  a  raw  potato,  with 
starch    grains    in    natural    condition. 

(Munson.) 


360  MILITARY    HYGIENE. 

Other  plants  furnishing-  tuber-like  fleshy  rhizomes  used  for  food 
in  warm  countries,  including  the  southern  United  States,  are : 

Yam  (Dioscorea},  a  slender  twining  vine  with  often  enormous 
rhizomes,  ranking  next  in  value  to  the  sweet  potato  in  the  West 
Indies. 

Taro  or  Eddoes  (Colocasia),  also  frequently  cultivated  for  the 
beauty  of  its  huge,  arrow-shaped  leaves  ("  Elephant's  Ears  "). 

Tannier  or  Yantia  (Caladium) }  with  leaves  and  fleshy  rootstocks 
much  like  the  preceding. 


FIG.  72. —  Cells  of  a  thoroughly  boiled 

potato.     (Munson.) 
f 

ROOTS.  —  To  the  true  roots  belong  the  following  commonly  culti- 
vated plants : 

Sweet  potato  (Ipomaa),  species  of  morning  glory,  with  long 
creeping  stems,  cultivated  in  this  country  as  far  north  as  New 
Jersey  for  its  valuable  root,  which  contains  as  much  starch  as  the 
potato  and  about  6  per  cent,  of  sugar.  The  sweeter  and  more  juicy 
kinds  (often  miscalled  yam)  are  preferred  in  the  South,  whereas 
the  drier  and  mealy  kinds  are  in  greater  demand  in  northern 
markets. 

Cassava  (Manihot},  a  stout  herb  with  palmate  leaves  and  huge 
fleshy  roots  extensively  consumed .  in  tropical  and  semi-tropical 
America.  From  their  juice  is  obtained  the  starch  known  as  tapioca. 

The  ordinary  garden  roots,  such  as  carrot,  beet,  turnip,  parsnip, 
oyster  plant  and  radish.  They  are  watery  and  contain  little  nntri- 


VEGETABLE    FOODS. 


361 


tive  substances,  but  they  add  variety  and  pleasant  flavors  to  more 
substantial  foods.  Carrot  contains  6  per  cent,  of  sugar,  and  beet 
at  least  twice  as  much.  (Fig.  73.) 

Green  vegetables  consist  of  the  leaves  and 
stems  of  various  plants.  As  a  class  they  con- 
tain somewhat  less  carbohydrates  than  roots 
and  tubers,  but  a  little  more  protein  and  salts ; 
they  are  also  valuable  antiscorbutics ;  their  ap- 
petizing flavors  make  them  indispensable  ad- 
juvants to  a  well-ordered  dietary,  besides 
giving  it  bulk  and  promoting  the  action  of 
sluggish  bowels.  Cabbage  is  not  always  easily 
digested;  it  contains  sulphur,  which  may  pro- 
duce flatulence,  and  a  fair  proportion  of  potas- 
sium salts.  Lettuce  and  cresses  are  healthful 
and  digestible.  Celery  and  asparagus  have 
useful  diuretic  properties.  Onions  are  savory 
and  wholesome,  owing  much  of  their  value  to 
a  pungent  oil  containing  sulphur.  Vegetables 
such  as  celery,  lettuce  and  all  others  eaten  in 
salad  and  which,  therefore,  do  not  undergo 
the  purification  of  fire,  are  liable  to  convey  the 
eggs  of  parasites  and  pathogenic  germs;  they 
should  always  be  carefully  washed  before 
being  prepared  for  the  table. 

Fruits  Used  as  Vegetables.  —  They  include 
melon,  cucumber,  squash,  pumpkin,  egg-plant, 
tomato,  etc.,  all  very  watery,  the  melon  and 
tomato  containing  as  much  as  95  per  cent,  of 
water,  but,  nevertheless,  useful,  palatable  and 
wholesome.  Tomato  contains  nearly  as  much 
organic  acids  as  potato,  and  as  it  is  mostly 
consumed  raw,  more  of  them  are  available  in 


FIG.  73. —  The  com- 
position of  the  carrot 
and  the  loss  of  nutri- 
ents when  boiled :  a, 
fiber,  starch,  fat,  etc.; 
b,  sugar;  c,  nonpro- 
teid  nitrogenous  mat- 
ter; d,  proteid  nitrog- 
enous matter;  e,  min- 
eral matter.  The 
hatched  portion  rep- 
resents the  loss  when 
medium-sized  pieces 
were  boiled. 


the  body,  giving  it  valuable  antiscorbutic  qualities. 

Fruits  and  Nuts.  —  Fruits,  properly  so-called,  are  mostly  used  in 
the  raw  state,  as  relish  and  dessert,  for  their  pleasant  acidulous 
taste.  They  may  be  divided  into  pulpous  fruits  (apples,  peaches, 
cherries,  plums,  oranges,  strawberries,  etc.)  and  farinaceous  fruits 
(chestnut,  banana,  bread-fruit,  etc.).  The  former  are  very  watery, 


362  MILITARY    HYGIENE. 

containing  sugar,  acids,  gum  and  pectin  in  variable  proportions  and 
having  but  little  value  as  food ;  the  latter  contain  a  notable  amount 
of  starch  and  sugar  and  have  decided  nutritive  value. 

Nuts  (see  composition,  page  350)  are  rich  in  proteins,  carbohy- 
drates and  especially  in  fats;  they  constitute  a  highly  nutritious 
food,  but  greatly  tax  the  digestive  powers.  As  dessert  they  should 
be  eaten  sparingly. 

Peanut  belongs  to  the  pulses  botanically  and,  like  them,  is  rich  in 
protein ;  but,  as  food,  is  more  akin  to  the  true  nuts  by  its  high  pro- 
portion of  fat.  When  roasted  and  ground  into  meal  it  is  somewhat 
oleaginous  and  marketed  as  peanut  butter. 


CHAPTER  XXVIII. 
THE  NUTRITIVE  VALUE  OF  FOODS. 

AMOUNT  NEEDED. 

We  take  food  to  build  and  repair  the  bodily  tissues,  as  well  as  to 
evolve  heat  and  the  necessary  energy  for  work.  The  body  is  a 
machine  capable  of  converting  potential  into  kinetic  energy.  The 
potential  energy  is  supplied  by  the  food,  and  the  metabolism  of  the 
tissues  converts  it  into  the  kinetic  energy  of  heat  and  mechanical 
power.  The  potential  energy  contained  in  any  foodstuff  is  deter- 
mined by  ascertaining  the  amount  of  heat  it  will  yield  on  complete 
combustion.  It  is  possible,  by  laboratory  experiment,  to  measure 
the  exact  amount  of  heat  liberated  by  the  burning  of  a  definite 
weight  of  food  in  a  calorimetric  bomb,  and  this  is  assumed  to  repre- 
sent the  energy  evolved  by  the  oxidation  of  the  same  quantity  in  the 
system.  This  assumption  is  correct  enough  in  the  case  of  fats  and 
carbohydrates,  which  are  completely  consumed  in  the  body  to  carbon 
dioxid  and  water,  but  needs  qualification  in  the  case  of  proteins 
which  are  only  oxidized  to  urea,  their  final  product  of  decomposition, 
so  that  their  physiological  value  is  about  25  per  cent,  less  than  their 
calorimetric  value. 

The  potential  energy  of  food  as  measured  by  the  amount  of  heat 
obtained  by  combustion,  is  expressed  in  units  of  heat  or  calories.  A 
calorie  is  the  amount  of  heat  required  to  raise  I  kilogram  of  water 
i°  C.  (or  one  pound  4°  F.).  A  "small  calorie"  is  the  amount 
required  to  raise  I  gram  of  water  i°  C.,  so  that  there  are  1,000 
small  calories  in  the  ordinary  or  large  calorie.  There  are  marked 
differences  between  the  various  proteins  as  regards  their  calorimetric 
or  fuel  value,  animal  proteins  having  a  greater  value  than  those  of 
vegetable  origin ;  the  same  difference  exists  between  animal  and 
vegetable  fats,  also  in  favor  of  the  former.  But,  for  practical  pur- 
poses, the  following  averages  of  the  physiological  value  of  the  three 
proximate  principles  of  foodstuffs,  as  determined  by  Rubner,  are 
generally  accepted. 


363 


364 


MILITARY    HYGIENE. 


I  gram  of  protein, 


=  4.1  calories.* 


I  gram  of  carbohydrates,       =4.1  calories, 
i  gram  of  fat,  =9-3  calories.f 

The  unit  of  mechanical  energy  of  food  used  in  this  country  is  the 
foot-ton,  that  is,  the  energy  required  to  raise  2,240  pounds  I  foot. 
One  calorie  is  equal  to  1.53  foot-tons.  Therefore  we  assume  that 
i  gram  of  fat,  oxidized  in  the  body,  evolves  sufficient  heat  to  warm 
9.3  kilos  of  water  i°  C,  or  sufficient  mechanical  energy  to  raise  14.2 
tons  one  foot.  Expressed  in  metrical  terms,  i  calorie  is  equivalent 
to  425.5  kilogram-meters,  that  is,  the  energy  required  to  raise  425.5 
kilograms  i  meter. 

An  adult  man  at  rest,  lying  down  but  not  sleeping,  has  been  found 
to  require  only  2,300  calories  (33  per  kilo  of  weight)  per  day  for 
the  normal  performance  of  all  the  animal  functions.  For  a  man  at 
work  must  be  added  the  calories  needed  for  the  greater  activity  of 
the  body  functions  and  the  muscular  energy  expended,  a  variable 
quantity. 

Of  the  calories  evolved  in  the  body  during  a  hard's  day's  work, 
300  or  more  are  expended  in  mechanical  energy.  The  remainder, 
according  to  Stewart,  are  given  off  as  heat  in  the  following 
proportions : 


From  the  skin  by 

From  the  lungs 
Heating  of  excreta 


radiation 

conduction 

convection 

evaporation  of  perspiration 

evaporation 

of  water 
heating  of  the 

expired  air 


80 
per  cent. 


17-5 
per  cent. 

2.5  per  cent. 


According  to  another  authority,  the  loss  of  heat  in  man  is  77  per 
cent,  by  radiation,  conduction  and  convection,  and  23  per  cent,  by 
water  evaporation.  (See  page  422.) 

*  Deduction  made  of  the  calorimetric  value  of  urea  passed  with  the  urine. 
If  a  further  reduction  is  made  for  the  escape  of  some  of  the  products  of 
combustion  of  the  proteins  in  the  feces,  the  value  would  be  nearly  exactly 
4  calories. 

t  According  to  Atwater,  the  latest  and  most  reliable  researches  give  the 
following  averages :  protein,  4  calories ;  carbohydrates,  4  calories ;  fats,  8.9 
calories ;  but  they  take  into  account  only  the  material  which  is  digested  and 
oxidized  and  actually  available  for  the  body 


THE    NUTRITIVE    VALUE   OF    FOODS.  365 

AMOUNT    OF   FOOD   NECESSARY. 

According  to  the  generally  accepted  standard  of  Carl  Voit,  a  man 
of  average  weight  (70  kilos  or  154  pounds),  doing  moderate  work, 
needs  118  grams  of  protein,*  500  grams  of  carbohydrate  and  56 
grams  of  fat,  with  total  fuel  value  of  3,055  calories.  This  was  found 
to  be  the  average  food  consumption  of  laboring  men  in  Germany. 
German  soldiers  in  active  service,  says  Voit,  eat  145  grams  of  protein, 
500  of  carbohydrate  and  100  of  fat,  with  fuel  value  of  3,574  calories. 
In  France,  according  to  Gautier,  the  ordinary  laborer  must  have  135 
grams  of  protein,  700  of  carbohydrate  and  90  of  fat,  with  fuel  value 
of  4,260  calories.  In  England,  weavers  were  found  to  take  151 
grams  of  protein,  with  enough  fat  and  carbohydrates  to  make  a  total 
fuel  value  of  3,475.  In  the  United  States,  according  to  Atwater,  a 
man  doing  moderately  active  muscular  work  consumes  125  grams 
of  protein,  with  enough  fat  and  carbohydrates  to  make  a  total  fuel 
value  of  3,400  calories,  while  when  doing  hard  muscular  work  the 
protein  is  increased  to  150  grams  and  the  fuel  value  to  4,150  calories. 
The  dietary  of  the  Yale  University  crew,  at  Gales  Ferry,  averaged 
171  grams  of  protein,  171  of  fat  and  434  of  carbohydrates,  with  fuel 
value  of  4,070  calories ;  that  of  Harvard  University  crew  averaged 
160  grams  of  protein,  170  of  fat  and  448  of  carbohydrates,  with  fuel 
value  of  4,074  calories  (Chittenden). 

Langworthy,  of  the  United  States  Department  of  Agriculture, 
appears  to  have  reached  conclusions  somewhat  at  variance  with  those 
of  the  preceding  observers ;  he  says :  "  In  the  average  of  a  large 
number  of  dietary  studies  with  men  at  moderately  active  muscular 
work,  the  quantity  of  'protein  in  the  food  actually  eaten  is  between 
100  and  105  grams  per  day."; 

For  the  healthiest  condition  of.  the  body  and  the  greatest  develop- 
ment of  energy,  the  three  proximate  principles  must  be  present  and 
combined  in  suitable  proportions ;  neither  proteins  nor  carbohydrates 
alone  could  supply  the  necessary  nutriment ;  fats,  on  the  other  hand, 
can  only  be  digested  and  absorbed  in  relatively  small  quantity,  while 
neither  carbohydrates  nor  fats  can  perform  the  essential  functions 
of  proteins ;  furthermore,,  the  digestive  fluids  are  obviously  intended 
to  act  upon  mixed  and  varied  foods.  The  relative  proportion  of 
these  food  constituents,  in  well  ordered  dietaries,  is  generally  set 
down,  in  round  numbers,  as  one  part  of  protein,  half  a  part  of  fat 

*  One  pound  of  protein  is  contained  in  6.4  pounds  of  beef  sirloin. 


366  MILITARY    HYGIENE. 

and  four  parts  of  carbohydrates,  the  proportion  of  nitrogen  to  carbon 
being  I  to  16  or  18.  The  amount  of  protein  should  not  fall  below 
1.69  grams,  according  to  Voit,  or  one  gram,  according  to  Lapicque, 
for  each  kilo  of  body  weight.  This  amount  varies  only  within 
narrow  limits ;  when  more  energy  is  required  for  an  increase  of 
muscular  work,  it  is  supplied  by  carbohydrates  and  fats,  especially 
the  latter,  which  possess  the  highest  fuel  value.  Fat  is  therefore  the 
element  of  the  dietary  which  oscillates  most,  in  accordance  with  the 
amount  of  work  performed  and  the  temperature  of  the  air. 

The  amount  of  food  stated  above  as  necessary  is  based  entirely 
upon  the  assumption  that  whatever  is  habitually  consumed  by  a  class 
of  men  is  a  correct  basis  upon  which  to  determine  the  actual  amount 
required  by  such  men.  But  it  is  obvious  that  such  an  assumption 
does  not  rest  upon  scientific  grounds  and  is  liable  to  lead  into  serious 
errors. 

The  ideal  diet.  —  Any  excess  over  what  is  really  necessary  to  meet 
the  wants  of  the  body  is  certainly  useless  and  may  be  harmful.  It 
should  always  be  remembered,  says  Atwater,  that  "  the  ideal  diet  is 
that  combination  of  foods  which,  while  imposing  the  least  burden  on 
the  body,  supplies  it  with  exactly  sufficient  material  to  meet  its 
wants."  According  to  Prof.  R.  H.  Chittenden,  who  has  devoted 
much  careful  study  to  this  question,  the  ideal  diet  is  the  smallest 
amount  of  proteins,  fats  and  carbohydrates :  "  sufficient  to  establish 
and  maintain  physiological  and  nitrogen  equilibrium,  sufficient  to 
keep  up  that  strength  of  body  and  mind  that  is  essential  to  good 
health,  to  maintain  the  highest  degree  of  physical  and  mental  activity 
with  the  smallest  amount  of  friction  and  the  least  expenditure  of 
energy,  and  to  preserve  and  heighten,  if  possible,  the  ordinary  resist- 
ance of  the  body  to  disease  germs."  To  determine  this  ideal  diet, 
habits  are  untrustworthy.  The  fact  that  they  are  shared  by  many 
individuals,  or  a  whole  nation,  does  not  prove  that  they  are  correct 
and  hygienic.  The  extent  to  which  we  indulge  our  cravings  for  food 
is  not  a  measure  of  the  extent  to  which  it  is  best  to  carry  such  indul- 
gence. In  many  communities,  a  large  proportion  of  the  men  drink 
and  smoke  immoderately  without  any  apparent  harm,  yet  no  one 
will  contend  that  such  habits  respond  to  any  actual  need  of  the  body 
economy,  subserve  any  useful  purpose  or  are  innocuous.  It  cannot 
be  denied  that,  at  table,  our  desire  for  food,  stimulated  by  the  senses 
of  taste,  smell  and  sight,  often  continues  to  be  gratified  after  all  the 


THE    XUTRITIVK    VALUK    OF    FOODS.  367 

needs  of  the  system  have  been  supplied.  To  overeat  is  one  of  the 
habits  most  easily  contracted,  often  long  tolerated  by  the  system 
without  obvious  protest,  and  always  most  difficult  to  correct.  It  is 
probably  the  origin  of  many  of  the  diseases  of  modern  civilized 
society,  and  therefore  no  question,  within  the  whole  field  of  preven- 
tive hygiene,  seems  more  worthy  of  careful  attention  than  the  exact 
determination  of  suitable  dietaries  for  all  conditions. 

The  food  constituent  which  is  most  commonly  eaten  in  excess  is 
the  protein.  Meat,  under  its  many  forms,  is  appetizing  and  savory, 
and  almost  always  an  important  part  of  the  diet  of  people  who  can 
afford  it.  But,  being  expensive,  we  find  it  used  much  more  abund- 
antly by  prosperous  and  rich  nations  than  among  poor  ones,  the 
latter  being  often,  from  necessity,  reduced  to  an  entirely  vegetable 
diet.  The  assertion,  sometimes  made,  that  the  most  civilized  nations 
have  reached  their  present  intellectual  standard  because  of  their  high 
consumption  of  meat  is  an  absurd  confusion  of  cause  and  effect. 

Conclusive  experiments.*  —  In  1902,  Prof.  Chittenden  began  a 
series  of  experiments  to  determine,  on  scientific  grounds,  the  amount 
of  proteins  necessary  to  maintain  the  best  physical  condition  of  the 
adult  body.  During  the  course  of  several  years,  he  experimented 
with  groups  of  professional  men,  athletes  and  soldiers,  gradually  and 
steadily  reducing  their  protein  food,  and  in  all  cases  with  the  same 
striking  and  convincing  result,  namely,  that  the  protein  constituent 
advocated  by  Voit  and  others  is  much  too  high,  at  least  twice  greater 
than  actually  necessary.  He  found,  by  multiplied  demonstrations, 
that  the  so-called  nitrogen  equilibrium,  that  is,  the  condition  of  the 
active  body  in  which  the  ingestion  and  excretion  of  nitrogen  balance 
each  other,  without  loss  of  body  weight,  can  be  easily  maintained 
with  a  daily  intake  of  0.85  gram  of  protein  per  kilo  of  body  weight, 
and  that  any  quantity  in  excess  of  this  is  wasted,  if  not  harmful. 
He  concluded  that  the  proper  diet  for  a  man  weighing  70  kilos  (154 
pounds)  should  not  exceed  60  grams  of  protein,  with  enough  fat 
and  carbohydrates  to  make  up  a  total  fuel  value  not  exceeding  2,800 
calories. 

The  13  soldiers  experimented  upon  by  Prof.  Chittenden,  during  a 
period  of  six  months,  were  fed  upon  this  reduced  diet,  which,  how- 
ever, within  the  terms  stated,  admitted  of  many  varied  combinations. 
They  led  an  active  life,  performing  each  day  a  certain  amount  of 

*  Physiological  economy  in  nutrition,  by  Russell  H.  Chittenden,  1904. 


368  MILITARY    HYGIENE. 

prescribed  exercise  in  the  gymnasium  in  addition  to  their  regular 
drill  and  ordinary  duties.  Their  weight  remained  practically  the 
same,  several  losing  one  or  two  pounds  during  the  first  few  weeks 
and  their  weight  remaining  stationary  thereafter.  At  the  end  of  the 
experiment,  they  were  in  the  best  of  health,  having  all  gained  materi- 
ally in  strength  and  endurance,  as  ascertained  by  careful  tests  in  the 
gymnasium. 

It  is  well  known  that  the  amount  of  nitrogen  excreted  rises  and 
falls  with  the  amount  ingested  and  is  directly  proportional  to  it, 
which  shows  that  there  is  no  appreciable  storing  of  it  even  when  the 
intake  is  very  much  increased ;  only  a  very  small  proportion  becomes 
transformed  into  living  organized  tissue,  most  of  it,  while  still  cir- 
culating in  the  fluids  of  the  body,  being  metabolized  into  urea  and 
thrown  out  as  of  little  or  no  value.  The  greater  energy  needed  for 
hard  or  violent  muscular  work  is  best  obtained  from  an  increased 
quantity  of  fats  and  carbohydrates,  and  so  long  as  these  principles 
are  freely  supplied  there  will  be  no  loss  of  muscular  tissue,  even 
though  the  protein  of  the  food  remains  unchanged. 

Food  which  contains  more  proteins  than  the  body  requires  is  not 
only  wasted,  but  there  is  every  reason  to  believe  that  it  is  positively 
dangerous.  The  many  decomposition  products  resulting  from  the 
breaking  down  of  the  circulating  unorganized  nitrogenous  material 
crowd  the  blood,  lymph  and  tissues ;  it  is  believed  that  they  impair 
the  phagocytic  function  of  the  white  blood-corpuscles,  that  is,  their 
power  to  ingest  and  destroy  the  pathogenic  bacteria  which  invade  the 
system;  it  is  also  probable  that  they  exert  an  inhibiting  effect  upon 
the  peripheral  endings  of  the  motor  nerves  or  upon  the  muscle  fibres 
themselves,  thus  impairing  the  functional  power  of  the  tissues,  caus- 
ing fatigue  to  be  readily  felt  after  exertion  and  loss  of  the  power  of 
endurance. 

We  know  that  gout  often  follows,  or  is  aggravated  by  a  free  meat 
diet,  doubtless  the  result  of  a  failure  of  the  nitrogenous  decomposi- 
tion products,  when  in  excess,  to  be  properly  oxidized  and  eliminated. 

A  consumption  of  protein  food  much  beyond  physiological  needs 
means  a  large  amount  of  urea  and  uric  acid,  as  well  as  amino-acids 
and  other  products  of  protein  decomposition,  which  must  be  passed 
out  through  the  kidneys,  thus  throwing  a  constant  strain  upon  those 
organs.  It  is  the  opinion  of  many  medical  authorities  that  a  large 
proportion  of  cases  of  high  blood-pressure,  leading  to  arteriosclerosis, 
are  due  to  an  effort  of  the  system  to  force  out  these  wastes. 


THE    NUTRITIVE    VALUE   OF    FOODS.  369 

Dr.  L.  Duncan  Bulkeley,  of  New  York,  with  all  the  authority  of  an 
eminent  specialist,  has  called  attention  to  the  relative  absence  of 
cancer  and  psoriasis  in  the  far  East,  as  well  as  among  Chinese  and 
Japanese,  and  other  countries  where  animal  food  is  sparingly  eaten. 
He  also  shows  by  conclusive  statistics  that  a  strictly  vegetarian  diet 
is  the  most  important  factor  in  the  treatment  of  psoriasis  and  various 
acute  inflammatory  affections  of  the  skin,  affections  in  which  the 
urine  is  found  to  contain  abundant  uric  acid  and  urates. 

Without  pretending  to  find  therein  any  necessary  relation  of  cause 
and  effect,  it  is  pertinent  to  note  that  the  United  States,  where  the 
consumption  of  meat  is  undoubtedly  greater  than  in  any  other  civil- 
ized nation,*  is  the  country  which  exhibits  the  highest  rates  for 
typhoid  fever.  It  also  shows  a  steady  increase  of  the  degenerative 
diseases  of  old  age,  so  that  the  longevity  of  people  past  50  is  less 
now  than  one  or  two  generations^  ago. 

Again,  we  know  that  many  symptoms  of  toxemia,  or  self-poison- 
ing, result  from  absorption  into  the  blood  of  anaerobic  putrefactive 
bacteria  and  their  toxins  from  the  large  intestines.  In  view  of  the 
fact  that  these  bacteria,  according  to  Dr.  C.  A.  Herter,  are  always 
more  abundant  in  the  intestinal  tract  of  carnivorous  than  of  herb- 
ivorous animals,  it  seems  quite  probable  that  a  free  meat  diet  pro- 
motes their  multiplication. 

Kendall,  of  Harvard,  found  that  the  intestinal  organisms  dominant 
on  a  protein  diet  are  the  Bacillus  subtilis  group,  B.  coll  and  various 
forms  of  B.  proteus,  with  alkaline  reaction  and  the  formation  of 
indol,  skatol  and  other  products  of  protein  putrefaction.  A  change 
of  diet  from  protein  to  carbohydrate  is  associated  with  the  develop- 
ment of  acid-forming  bacteria.  Some  bacteria  are  facultative  in 
their  metabolism,  producing  an  alkaline  or  acid  reaction  according 
to  the  culture  media ;  B.  coll,  for  instance,  when  grown  on  dextrose 
broth,  becomes  an  acid  former  instead  of  a  toxin  producer.  Toxic 
substances  from  protein  decomposition  are  not  found  to  any  extent 
in  media  containing  a  certain  amount  of  utilizable  carbohydrate. 
These  conclusions  are  in  accord  with  the  regime  recommended  by 
Metchnikoff  for  the  destruction  of  the  so-called  microbes  of  senility, 
namely,  low  protein  diet,  free  sugar  supply  and  direct  ingestion  of 

*  The  consumption  of  meat  per  capita  in  the  United  States,  in  1915,  was 
181  pounds,  while  England,  the  greatest  meat-eating  country  in  Europe,  only 
consumed  120  pounds  in  1913  and  1914. 


37O  MILITARY    HYGIENE. 

lactic-acid  bacilli  by  the  mouth.  From  his  observations,  Kendall  is 
led  to  recommend  lactose  (the  most  assimilable  form  of  sugar)  as 
an  essential  element  in  the  treatment  of  typhoid  fever,  cholera, 
dysentery  and  summer  diarrheas. 

Conclusions.  —  From  the  results  reached  by  Chittenden  and  other 
experimenters,  and  from  the  above  considerations,  we  are  irresistibly 
led  to  the  conclusion  that  the  standard  diet  of  Voit,  and  other  physi- 
ologists, must  be  modified  so  as  to  average  about  as  follows : 


Quantity 

Calories 

Protein  

60  grams 

24.6 

Fat  

60  grams 

558 

Carbohydrates  .  . 

500  grams 

2050 

Total,  2854 

Sixty  grams  of  protein  are  contained  in  about  10  ounces  of  fresh 
lean  beef ;  but  as  milk  and  eggs,  as  well  as  all  vegetable  foodstuffs, 
contain  nitrogen,  they  will  necessarily  contribute  a  large  part  of  the 
required  protein,  seldom  less  than  one-half,  so  that  the  amount  to  be 
supplied  in  the  form  of  flesh  (meat,  poultry,  fish)  will  seldom  ex- 
ceed 30  grams  (one  ounce),  contained  in  4  or  5  ounces  of  boneless, 
fresh,  lean  beef.  Thus  Prof.  Irving  Fisher,  of  Yale,  has  shown  by 
experiments  upon  students,  that  the  highest  degree  of  endurance  was 
reached  at  the  close  of  a  period  of  five  months,  upon  a  diet  which, 
beginning  with  a  daily  average  of  52  grams  of  protein  from  flesh 
foods,  and  total  fuel  value  of  2,830  calories,  was  reduced  to  about  8 
grams  from  flesh  foods,  with  total  fuel  value  of  2,220  calories. 

This  subject  is  further  considered  in  connection  with  the  chapter 
on  Rations. 


CHAPTER    XXIX. 

FIELD  COOKING  AND  BAKING.* 

This  very  important  subject  has  not  yet  received  the  study  which 
it  deserves  nor  reached  the  development  of  which  it  is  capable. 
Under  field  conditions  the  cooking  outfit  should  be  as  light  and 
simple  as  possible,  but  experience  has  shown  that,  even  then,  it  is 
generally  practicable  to  provide  each  company  with  a  few  utensils, 
carried  by  pack  animals  or  wheeled  transport,  which  will  greatly 
contribute  to  the  comfort  of  the  men  and  the  improved  quality  of 
their  food. 

In  the  absence  of  field  ranges,  the  most  easily  improvised  kitchen 
consists  of  a  trench  4  feet  long,  dug  in  the  direction  of  the  wind, 
with  chimney  at  the  leeward  end,  one  or  two  feet  high,  built  of  sod, 
stone  or  mud;  the  trench  should  be  a  foot  deep,  well  open  at  the 


FIG.  74. —  Excavated  fire-place  inside  of  bank. 

windward  end,  where  the  fire  is  made,  and  shallow  up  under  the 
chimney,  its  width  being  2  inches  less  than  that  of  the  kettles;  if 
material  is  at  hand,  it  can  be  closed  above  so  as  to  make  a  regular 
flue,  leaving  two  or  three  openings  for  the  kettles.  As  the  wind 
changes,  another  trench  is  dug  accordingly,  leading  under  the  same 
chimney.  Several  trenches  may  thus  radiate  from  the  same  chim- 
ney, those  not  in  use  being  temporarily  clogged  up.  If  time  permits, 

*  Manual  for  the  Subsistence  Department,  1910.     Manual  for  Army  Cooks, 
1910.    Handling  the  straight  Army  Ration  and  Baking  Bread.  T.  L.  Holbrook. 

371 


372 


MILITARY    HYGIENE. 


a  crane  can  be  put  up,  consisting  of  a  pole  supported  on  two  forked 
uprights,  or  of  an  iron  crossbar  with  hooks  for  hanging  the  pots. 

In  clayey  soil,  an  underground  horizontal  flue,  one  foot  square,  is 
dug  in  the  side  of  a  bank,  one  foot  from  the  surface  of  the  ground, 
and  its  internal  end  connected  with  a  chimney.  Along  its  course, 
openings  are  made  in  which  to  place  the  kettles.  (Fig.  74.) 

•  Economy  of  fuel  often  demands  that  company  cooking  fires  should 
also  be  utilized  to  destroy  as  much  of  the  garbage  as  possible.  The 
regular  kitchen  incinerator  is  described  on  page  668.  Cooking  over 
the  incinerator  fire  is  often  practicable  and  desirable.  For  this  pur- 
pose the  long-legged  "  spider,"  supplied  to  various  militia  regiments, 
is  the  best  fixture  whereon  to  set  kettles  and  pots.  The  regulation 
field  range  necessarily  requires  a  separate  fire,  but  even  in  such  a 
fire  much  of  the  wastes  can  be  burned  up. 

In  the  field,  the  individual  mess  kit  of  the  American  soldier  con- 
sists of  canteen  with  cup,  and  meat  can.  (See  under  Equipment.) 

The  only  cooking  device  now  supplied  troops  in  the  field  is  the 


FIELD    COOKING   AND    BAKING. 


373 


Army  field  range,  in  two  sizes,  No.  i  and  No.  2 ;  the  former  weighs 
approximately  264  pounds,  with  Alamo  attachment  and  utensils, 
and  is  designed  to  cook  for  150  men;  the  latter  weighs  about  150 
pounds,  with  utensils,  and  is  designed  for  55  men ;  it  is  without  the 
Alamo  attachment.  (Fig.  75.)  Both  consist  essentially  of  a  sheet- 
iron  cover,  or  boiling  plate,  with  turned  down  edges,  under  which 
the  fire  is  made,  and  the  oven  or  roaster  (41),  which  is  a  sheet-iron 
box  with  double  walls  and  top,  surmounted  by  the  smoke-stack. 
In  No.  i  the  boiling  plate  has  three  sections,  42,  42A  and  426,  the 
last  two  forming  the  Alamo  attachment.  (Fig.  76.)  The  heat 
is  drawn  from  the  fireplace  to  the  space  between  the  walls,  thus 
enveloping  the  oven  and  being  thoroughly  utilized.  The  range 
should  be  set  up  with  the  firing  end  to  the  wind,  and  the  sides 
banked  just  enough  to  seal  cracks.  A  slight  excavation  under  the 
boiling  plate  will  make  a  larger  firing  place  and  prove  more  satis- 
factory. It  can  boil,  roast,  fry  and  stew  any  of  the  components  of 
the  ration.  If  installed  upon  a  pit  filled  with  stones  (see  Company 
Incinerator),  it  is  possible  to  burn  much  of  the  garbage  in  the  fire 
and  to  evaporate  most  of  the  liquid  wastes  on  the  heated  stones. 

When  prepared  for  transportation,  with  utensils  nested  inside, 
No.  i  makes  a  package  32  x  20  x  16  inches  in  size  which  can  be 
packed  on  a  mule  by  placing  the  oven  on  one  side  and  the  boiling 
plate  with  utensils  on  the  other  side,  making  a  well-balanced  load. 


FIG.  76. —  Field  Range  No.  i  in  position. 


3/4  MILITARY    HYGIENE. 

When  transportation  ceases  to  be  available,  it  is  left  behind,  except 
the  boilers  and  other  utensils,  which  are  carried  by  the  cooks  as  far 
as  practicable. 

Cooking  in  paper  bags,  as  now  frequently  practised  in  many  house- 
holds, seems  to  be  worth  trying  in  the  field  range.  Meats  and 
vegetables  can  thus  be  cooked  in  less  time  and  with  less  fuel ;  they 
require  less  attention,  no  basting,  for  instance,  being  necessary; 
there  is  no  shrinkage  and  hardly  any  loss  of  juices  or  of  nutritive 
properties. 

Fireless  Cooker.  —  Any  cooking  device  saving  fuel  and  time  is 
worthy  of  consideration  in  the  field,  and,  on  that  account,  much 
attention  has  been  given,  of  late  years,  to  the  so-called  self-cooking 
stove  or  fireless  cooker.  It  consists  of  a  strong  box  closing  tightly 
and  containing  vessels  in  which  the  articles  of  food,  partly  cooked, 
are  placed.  The  vessels  fit  snugly  in  the  box  and  are  surrounded  on 
all  sides  by  a  thick  layer  of  some  non-conductive  substance.  The 
food  prepared  in  the  ordinary  way  and  placed  in  the  vessels  is  boiled 
or  otherwise  cooked  for  a  short  time  (20  to  30  minutes)  in  a  range 
or  over  a  fire,  and  the  vessels,  securely  clamped  down,,  are  returned 
to  the  box.  Usually,  heated  soapstones,  in  the  shape  of  disks,  are 
used  as  radiators,  one  being  placed  beneath  and  the  other  (when 
necessary)  over  the  vessel.  As  the  loss  of  heat  is  very  small,  the 
temperature  of  the  vessels  is  not  sensibly  lowered,  and  the  food 
continues  to  cook  until  it  is  thoroughly  and  evenly  done,  requiring 
about  twice  the  time  that  would  be  taken  in  an  ordinary  stove.  A 
longer  stay  in  the  cooker  is  said  not  to  be  detrimental  to  the  quality 
of  the  food  inasmuch  as  there  is  no  loss  by  evaporation.  (Fig.  77.) 

This  system  of  cooking  possesses  advantages  for  the  field ;  it 
greatly  economizes  fuel  and  gives  the  men  a  well-cooked  meal  on 
their  arrival  in  camp.  Where  wood  cannot  be  procured  it  might  be 
exceedingly  valuable.  On  the  other  hand,  it  requires  a  heavy  and 
rather  unwieldly  apparatus  which  does  not  take  the  place  of  the  field 
range,  but  only  supplements  it,  thus  adding  materially  to  the  weight 
of  the  company  baggage.  On  this  account  the  general  opinion  of 
competent  observers  is  adverse  to  its  use  for  military  purposes.  It 
seems  probable,  however,  that  a  combination  of  coal-oil  stove  and 
fireless  cooker  (as  already  found  in  trade)  could  be  developed  in 
such  manner  as  to  be  quite  adaptable  to  permanent  and  semi-per- 
manent camps. 


FIELD    COOKING   AND    BAKING. 


FIG.  77. —  "  Caloric "  Fireless  Cookstove,  with  storage  cabinet  below.  The 
equipment  consists  essentially  of  three  kettles  with  seamless  aluminum  lining, 
six  radiators,  trays,  baking  racks,  radiator  racks  and  tongs.  The  covers  are 
equipped  with  valve  that  allows  the  excess  steam  to  escape. 

Gas  Cooker.  —  For  traveling  detachments,  in  trains  or  wherever 
gas  is  obtainable,  the  Q.  M.  Corps  provides  a  convenient  and  porta- 
ble cooking  appliance,  the  "  Gas  Cooker,"  compactly  packed  in  one 
trunk. 

Baking  Ovens.  —  In  the  field,  portable  ovens  should  be  provided 
whenever  practicable;  in  our  Army,  the  old-type  field  oven  is  made 
of  two  pieces  of  sheet  iron,  so  curved  that  when  their  upper  edges 
are  connected  and  the  lower  edges  fixed  in  the  ground,  they  form  an 
arch  5  feet  long,  3  feet  9  inches  wide,  and  I  foot  8  inches  high ;  the 
front  is  closed  by  a  two-handled  iron  door  and  the  rear  by  a  plate ; 
when  set  up,  the  whole,  excepting  the  door,  is  covered  with  a  layer 
of  earth ;  the  door  serves  both  as  draft  and  vent  for  the  smoke. 
(Fig.  78.)  Such  an  oven,  if  kept  in  constant  operation  for  24  hours, 


376 


MILITARY    HYGIENE. 


Field    Oven 


Manner  of  hooking  sides  together   a 


FIG.  78. —  Field  oven  for  baking  bread. 

can  bake  enough  bread  for  1,000  men.  A  larger  size  is  also  sup- 
plied, 6  feet  long  and  4  'feet  wide,  formed  of  three  pieces  of  sheet 
iron ;  it  is  operated  in  the  same  manner. 

A  larger  and  more  efficient  field  oven  is  that  devised  by  W.  H. 
Hart  of  the  Q.  M.  Corps,  and  known  as  field  oven  No.  i.  (Fig.  79.) 
It  is  a  knock-down  steel  structure  containing  three  tiers  of  pans,  and 
designed  for  continuous  baking.  Its  base  is  banked  around  with 
earth  and  the  fire  made  in  a  pit  underneath.  The  top  is  covered 
with  sand  to  prevent  loss  of  heat.  The  walls  are  double,  and, 
through  the  space  between  them,  as  well  as  through  the  space 
between  the  tiers  of  pans,  the  flames  and  smoke  freely  circulate,  so 
that  all  parts  of  the  oven  are  bathed  in  heat.  This  oven  has  the 
great  merit  of  a  large  output  (from  3,000  to  3,600  rations  per  day) 
with  comparatively  little  fuel. 

Baking  ovens  can  be  readily  improvised,  as  shown  in  Fig.  80. 
On  the  left  is  seen  a  mud  oven  made  by  moulding  sand  or  loam  over 
two  barrels  placed  end  to  end,  the  moulds  thus  formed  being  cov- 
ered with  about  6  inches  of  clay,  into  which  hay  or  straw  has  been 
chopped.  The  oven  is  allowed  to  dry  in  the  sun  for  about  two  days 
and  then  baked  by  slow  fire.  In  the  absence  of  barrels,  a  frame- 
work of  flexible  twigs  closely  wattled  together  will  answer  the  same 
purpose. 


FIELD    COOKING   AND    BAKING. 


377 


FIG.  79. —  Field  Oven  No.  i. 

In  the  bank  are  seen  two  simple  excavated  ovens,  one  with  mouth 
built  out  and  narrowed. 

On  the  right  is  seen  a  mud  range  constructed  in  the  same  manner 
as  the  oven  first  described,  except  that  suitable  holes  are  left  in  the 
top  for  kettles.  A  mud  chimney  should  be  added  if  time  permits. 

In  all  these  types  of  draw-fire  ovens  the  fire  is  built  in  the  oven 
2  or  3  hours  before  baking;  the  coals  are  then  withdrawn,  the  mouth 
closed  (if  possible)  to  equalize  the  heat,  and  the  baking  begun  when 
the  temperature  is  sufficiently  reduced,  that  is  to  say,  when  the  bare 
arm  can  be  retained  in  the  oven  12  to  15  seconds.  Such  ovens  are 
much  more  efficient  if  built  upon  a  stone  or  brick  floor. 

Dutch  ovens  are  also  convenient  for  baking  bread,  when  at  hand. 

FIELD  COOKING  OF  FOREIGN  ARMIES. 

For  cooking  in  the  field,  European  troops  were,  until  lately,  left 
entirely  dependent  upon  what  they  carried  on  their  persons.  But 
after  the  Russo-Japanese  War,  having  recognized  the  advantages  of 


378  MILITARY    HYGIENE. 


FIG.  80. —  Improvised  field  ovens. 

the  Russian  ambulant  kitchen,  Germany,  France,  England  and  other 
countries  conducted  experiments  which  have  led  to  its  general 
adoption,  with  such  modifications  as  were  deemed  advisable. 

The  Japanese  field  cooking  outfit  consists  of  a  stove  or  segmented 
cylinder  of  sheet  iron,  22  inches  in  diameter,  without  top  or  bottom  ; 
of  a  thin  cast  iron  kettle  which  fits  into  the  stove ;  of  the  rice  boiler 
or  colander  which  rests  by  handle  lugs  on  the  rim  of  the  kettle ;  and 
of  various  cans  and  small  utensils.  Four  cooking  outfits  are  allowed 
for  a  company  of  235  men.  (Fig.  81.)  They  are  transported  on 
pack  animals,  each  stove  knocked  down  into  six  segments.  (Fig. 
82.)  Such  outfit  is  specially  adapted  to  a  ration  consisting  chiefly 
of  rice.  The  individual  mess-can  of  the  Japanese  soldier  contains 
several  compartments  for  pickles,  vegetables  and  sauces,  and  is  also 
used  to  cook  rice  (Kuhn). 

The  Russian  field  cooking  system,  now  in  actual  use  by  all  the 
belligerent  armies  in  the  present  European  War,  is  doubtless  the 
best  as  yet  devised,  having  successfully  stood  the  test  of  hard  cam- 
paigns. It  is  practically  an  ambulant  kitchen  mounted  on  wheels. 
Two  sizes  are  used,  the  larger  for  an  infantry  company  of  240  men, 
on  four  wheels  drawn  by  two  horses  (Fig.  83),  and  the  smaller  for 
a  cavalry  troop  of  120  men,  on  two  wheels  drawn  by  one  horse 
(Fig.  84).  The  cooking  proceeds  while  on  the  march,  so  that,  on 
getting  into  camp,  the  men  do  not  have  to  wait  for  their  meal. 


FIELD    COOKING    AND    BAKING. 


379 


FIG.  81. —  Japanese  field  company  kitchen.     (Kuhn.) 


Two  types  were  used  by  the  Russian  troops  in  Manchuria,  one 
devised  by  Colonel  Braiin  and  the  other  by  Colonel  Debronrawoff. 
The  Braun  type,  which  was  by  far  the  most  common,  consists 
essentially  of  a  boiler,  with  fire-box  and  chimney.  The  boiler  is 
double,  the  inner  wall  of  copper,  tinned  inside,  the  outer  of  iron 
lined  with  asbestos.  The  lid  can  be  screwed  down  air-tight  so  that 
the  contents  are  cooked  under  considerable  pressure,  the  danger  of 
explosion  being  prevented  by  a  safety  valve.  A  perforated  alumi- 
num bottom,  for  cooking  grits  or  cereals,  can  be  placed  in  the 
boiler.  This  type  therefore  admits  only  of  boiling  and  steaming, 
which  is  not  much  of  an  objection  in  the  case  of  the  Russian 
soldier  accustomed  to  soup  and  boiled  meat.  For  officers,  a  special 
form  is  constructed  which  admits  of  boiling,  steaming  and  roast- 
ing. (Fig.  85.)  The  Debronrawoff  type  is  somewhat  more  com- 
plex, but  equally  strong  and  practical,  admitting  of  boiling,  roasting 
and  stewing. 

The  Russian  system  is  ideal  in  principle  and,  with  a  few  modifica- 
tions, could  be  readily  adapted  to  our  service;  not  only  would  it 
supply  varied  and  well-cooked  food  with  least  trouble  and  when 
most  needed,  but  also  sterilized  water.  The  chief  objection  against 
it  is  the  additional  transportation  involved,  namely,  one  horse  or 


3So 


MILITARY    HYGIENE. 


FIG.  82. —  Japanese  field  stoves  and  kettles  packed  on  regulation  saddle. 

(Lynch.) 


FIG.  83. —  Russian  wheeled  kitchen  for  a  company  of  infantry  in  the  field. 


FIELD   COOKING   AND    BAKING. 


FIG.  84. —  Russian  wheeled  kitchen  for  a  company  of  cavalry  in  the  field. 


FIG.  85. —  Russian  wheeled  kitchen  for  officers  in  the  field. 


382  MILITARY    HYGIENE. 

mule  per  company.  It  must  be  remembered,  however,  that  the  one 
wagon  allowed  each  company  to  carry  all  its  baggage  and  supplies 
will  often  be  overloaded  or  insufficient,  and  that  the  ambulant  kitchen 
would  be  the  easiest  and  most  effective  method  of  relief. 

In  the  Norwegian  service,  a  cooking  outfit  mounted  on  wheels  has 
also  been  tried,  but  instead  of  kettle  and  fire-box,  a  fireless  cooker  is 
used,  a  system,  for  reasons  already  stated,  deemed  unsatisfactory. 


CHAPTER    XXX. 


THE    RATION. 

A  ration  is  the  allowance  for  the  subsistence  of  one  person  for  one 
day,  and  varies  in  components  according  to  the  station  of  the  troops 
or  the  nature  of  the  duty  performed,  being  severally  known  as  the 
garrison  ration,  the  travel  ration,  the  reserve  ration.,  the  field  ration, 
the  Filipino  ration  and  the  emergency  ration. 

I.  Garrison  Ration. 

The  garrison  ration  is  intended  for  troops  not  only  in  garrison, 
but  also  in  camps  and  during"  maneuvers,  and  wherever  practicable 
in  peace  and  war.  It  is  as  follows : 


Component  articles. 

Quantities. 

Substitutive  articles  and  quantities  in  ounces. 

Mutton,  fresh  

20 

12 

Canned  meat,  when  impracticable  to  furnish 
fresh  meat  

16 

Beef,  fresh. 

Hash,   corned   beef,   when   impracticable   to 
furnish  fresh  meat  

16 

Fish,  dried.                                                    

14 

Fish,  pickled  

18 

Fish,  canned  

16 

Turkey,  dressed,  on  Thanksgiving  Day  and 
Christmas,  when  practicable  

16 

Soft  bread  

18 

Flour  

1  8  oz. 

Hard  bread,  to  be  issued  only  when  the  in- 

|      terests  of  the  government  so  require  
1  Corn  meal  .    . 

16 
20 

f  Rice  

i  6 

\  Honvny  

i  6 

Potatoes,  canned  

IS 

Potatoes!  

Onions,  in  lieu  of  an  equal  quantity  of  pota- 
toes, but  not  exceeding  40  per  centum  of 
total  issue. 
Tomatoes,  canned,  in  lieu  of  an  equal  quantity 
of  potatoes,  but  not  exceeding  20  per  cen- 

tum of  total  issue. 
Other   fresh   vegetables    (not    canned)    when 
they  can  be  obtained  in  the  vicinity  or 
transported  in  a  wholesome  condition  from 
a  distance,  in  lieu  of  an  equal  quantity  of 
potatoes,  but  not  exceeding  30  per  centum 
iof  total  issue. 

1.28 

1.28 

Prunes  •    

I  .  28  OZ. 

Jam,  in  lieu  of  an  equal  quantity  of  prunes, 
|      but  not  exceeding  50  per  centum  of  total 
(issue. 

1.  12 

Coffee,  roasted  and  ground 

I  .4 

•  32 

Sugar  

Milk,  evaporated,  unsweet- 
ened   

Vinegar  

1  6  gill 

Pickles,  cucumber,  in  lieu  of  an  equal  quan- 

tity of  vinegar,  but  not  exceeding  so  per 
centum  of  total  issue. 

*  In  Alaska,  16  ounces  bacon  or,  when  desired,  16  ounces  salt  pork,  or  22  ounces  salt  beef, 
t  In  Alaska  the  allowance  of  fresh  vegetables  will  be  24  ounces  instead  of  20  ounces,  or  canned 
potatoes,  1 8  ounces  instead  of  15  ounces. 


383 


MILITARY    HYGIENE. 


Component  articles. 

Quantities. 

Substitutive  articles  and  Quantities  in  ounces. 

Salt 

.014 
.014 
.014 

•  5 

.014 

.04  oz. 

.014  oz. 
.  64  oz. 

f  Cloves  

Lard    

[  Nutmeg  

Butter  

.5    oz. 

Oleomargarine  .... 

Syrup  

.32  gill 

Vanilla 

NOTE. — Food  for  troops  traveling  on  U.  S.  Army  transports  will  be  prepared  from  the  articles 
of  subsistence  stores  which  compose  the  ration  for  troops  in  garrison,  varied  by  the  substitution  of 
other  articles  of  authorized  subsistence  stores,  the  total  cost  of  the  food  consumed  not  to  exceed 
24  cents  per  man  per  day,  except  on  Thanksgiving  Day  and  Christmas,  when  not  exceeding  39 
cents. 

The  fuel  value,  in  calories,  of  the  principal  components  is  as 
follows : 


Component  articles 

Quantity 
in  ounces 

Fuel  value 
in  calories 

Fresh  beef    

20 

1287 

Fresh  mutton    

20 

1440 

Bacon.  

12 

2040 

Dried  fish  

14 

276 

Pickled  fish             

18 

IO2O 

Canned  fish    

16 

680 

Flour  

18 

1828 

Soft  bread    

18 

1355 

Hard  bread    

16 

1712 

Corn  meal  

20 

IQ86 

Beans  

2.4 

228 

Rice  

1.6 

160 

Hominy  

1.6 

172 

Potatoes  

20 

368 

Sugar  

3.2 

350 

Lard  

0.64 

160 

Butter  

o.  S 

106 

Sirup  

1.3 

192 

The  garrison  ration,  as  may  be  seen,  admits  of  many  combinations 
which  insure  variety.  It  is  comprehensive  and  elastic  and  can  be  ad- 
justed to  any  climate.  By  selecting  the  most  nutritive  articles,  such 
as  bacon,  hard  bread  or  cornmeal,  beans,  potatoes,  dried  fruit,  butter 
and  sirup,  we  can  obtain  from  it  a  maximum  fuel  value  of  5,378 
calories,  according  to  Langworthy,  or  5,674  calories,  according  to 
Wiley.  On  the  other  hand,  by  using  such  articles  as  dried  fish,  soft 
bread,  rice,,  potatoes,  canned  tomatoes  and  dried  fruit,  the  fuel  value 
can  be  reduced  to  2,500  calories.  The  average  garrison  ration, 
habitually  consisting  of  fresh  beef,  soft  bread,  beans,  potatoes  and 


THE   RATION.  385 

onions,  dried  fruit,  butter,  sirup  and  sugar  (or  their  nutritive  equiva- 
lents), weighs  65  ounces  and  contains  99  grams  of  fat,  481  of  carbo- 
hydrates and  157  of  proteins,  with  total  fuel  value  of  3,536  calories. 

Fresh  meats  are  ordinarily  issued  seven  days  in  ten,  and  bacon 
three  days. 

The  garrison  ration  is  often  supplemented  by  articles  obtained 
from  the  post  garden  or  purchased  from  the  company  fund,  and 
which  largely  contribute  to  give  it  variety  and  appetizing  value. 

In  order  to  facilitate  the  supplying  of  troops  and  the  keeping  of 
accounts,  the  former  system  of  issue  has  been  replaced  by  that  of 
purchase. 

"All  articles  of  the  garrison,  travel  or  Filipino  ration  due  a  com- 
pany, or  other  military  organization,  will  he  retained  by  the  Q.  M. 
Corps  and  credit  given  to  the  organization  for  the  money  value  of 
these  articles  at  the  current  price  of  the  articles." 

The  stores  required  by  the  organization  will  be  purchased  from 
the  Q.  M.  Corps,  and  the  latter  will  pay  as  savings  to  the  organiza- 
tion commander  any  excess  in  value  of  the  stores  retained  over  those 
purchased.  At  the  end  of  the  month,  or  whenever  necessary,  the 
organization  commander  will  settle  the  account  with  the  Q.  M. 
Corps,  when  the  savings  to  the  organization,  or  the  amount  due  to 
the  Q.  M.  Corps,  as  the  case  may  be,  will  be  paid  and  the  account 
certified  as  required. 

The  price  of  bread,  as  charged  against  organizations,  is  deter- 
mined by  adding  together  the  cost  of  flour  and  other  ingredients 
used,  the  extra-duty  pay  of  the  bakery  personnel  and  the  cost  of  the 
power  used  in  operating  the  baking  machinery,  and  then  dividing 
by  the  total  number  of  pounds  of  bread  baked.  It  follows  that  the 
organizations  are  thus  given  the  benefit  of  whatever  savings  accrue 
from  the  conversion  of  flour  into  bread  after  deduction  of  all 
expenses. 

"  Money  accruing  from  the  '  ration  and  savings  account '  of  an 
organization  will  be  spent  only  for  food." 

All  articles  of  the  ration  required  for  the  supply  of  troops  will  be 
obtained  from  the  Q.  M.  Corps  when  on  hand,  but  should  any 
organization  want  more  of  any  article  than  is  allowed  by  regulation, 
the  excess  may  be  purchased  elsewhere ;  or  if  any  article  is  not  in 
stock  it  can  likewise  be  bought  elsewhere. 

When  necessary  to  renew  reserve  rations,  or  to  avoid  loss  of 
ration  articles  that  have  accumulated,  the  commanding  general  or 


386  MILITARY    HYGIENE. 

commanding  officer,  as  the  case  may  be,  may  order  the  issue  of  such 
supplies  to  troops,  not  to  exceed  the  ration  allowance  and  only  for 
such  time  as  the  interest  of  the  Government  requires. 

The  value  of  the  garrison  ration  is  estimated  at  30  cents;  the 
Filipino  ration  at  20  cents,  and  the  travel  ration  at  40  cents. 

Under  circumstances  when  enlisted  men  or  nurses  cannot  be  fur- 
nished with  rations  in  kind,  or  it  is  impracticable  to  carry  them, 
commutation  may  be  allowed  at  rates  ranging  from  25  cents  to  $1.50 
a  day. 

The  ration  of  enlisted  men  sick  In  hospital,  and  of  female  nurses 
while  on  duty  in  hospital,  is  commuted  at  the  rate  of  30  cents  per 
ration,  except  that  at  the  general  hospital  at  Fort  Bayard,  N.  M.,  50 
cents  per  ration,  and  at  other  general  hospitals,  40  cents  per  ration, 
is  authorized  for  enlisted  patients  therein. 

Other  issues  of  stores,  not  components  of  rations,  may  be  author- 
ized when  necessary  for  the  public  service,  and  made  on  ration 
returns,  approved  by  the  commanding  officer,  such  as  soap,  candles, 
matches,  toilet  paper,  towels  and  ice. 

Ice.  —  Ice  is  issued  by  the  Q.  M.  Corps  to  organizations  of  enlisted 
men  as  follows :  For  each  ration,  4  pounds,  the  maximum  allowance 
to  any  organization  or  detachment  of  less  than  100  men  to  be  100 
pounds  a  day,  and  to  organizations  of  100  men  or  more  to  be  i 
pound  a  day,  per  man.  The  full  allowance  may  be  issued  for  the 
entire  year  to  troops  stationed  south  of  the  37th  parallel.  To  troops 
stationed  north  of  the  37th  parallel,  and  where  from  any  cause  it  is 
impracticable  to  cut  and  store  ice  for  their  use,  the  allowance  will  be 
only  for  the  summer  months,  from  April  i  to  October  31.  A  special 
allowance  is  provided  for  States  on  the  Pacific  Coast. 

II.  Travel  (or  Cooked)  Ration. 

Issued  to  troops  traveling  otherwise  than  by  marching,  and  sepa- 
rated from  cooking  facilities. 

Component  articles  and  quantities 
in  ounces 

Soft  bread 18  or  Hard  bread  16 

Beef,  corned  \?.  or  Hash,  corned  beef 12 

Beans,  baked   4 

Tomatoes,  canned    8 

Jam 1.4 

Coffee,  roasted  and  ground...  1.12 

Sugar 2.4 

Milk,  evaporated,  unsweetened.       .5 


THE   RATION.  387 

Its  fuel  value  is  about  2,735  calories. 

Enlisted  men  supplied  with  travel  rations  may,  in  lieu  of  the 
coffee,  milk  and  sugar  components  thereof,  receive  funds  for  the 
purchase  of  liquid  coffee,  at  the  rate  of  21  cents  per  day  for  each 
man. 

III.  Reserve  (or  Haversack)  Ration. 

Issued  to  troops  in  the  field  when  beyond  the  advance  supply 
depots.  It  is  carried  on  the  person  of  the  men  and  in  the  trains, 
and  constitutes  the  reserve  for  field  service. 

Component  articles  and  quantities 
in  ounces 


Bacon 


or  meat,  canned. 


Hard  bread 

Coffee,   roasted  and  ground. 

Sugar  

Salt  . 


12 

16 
16 

I. 12 
2.4 
.16 


These  articles  contain  about  218  grams  of  fats,  489  of  carbohy- 
drates and  113  of  proteins,  with  total  fuel  value  of  4,448  calories. 

Should  it  be  found  practicable  to  supplement  it  by  local  purchase 
or  otherwise,  the  commanding  general  may  direct  the  issue  in  kind 
of  such  additional  articles  of  food  as  are  available,  at  whatever  cost, 
but  not  in  excess  of  the  amounts  allowed  of  corresponding  articles 
in  the  garrison  ration. 

The  bacon  is  contained  in  a  rectangular  tin  can  with  capacity  for 
two  rations.  The  sugar,  coffee  and  salt  are  contained  in  another 
rectangular  tin  can,  2^2  inches  square,  5  inches  long,  and  with 
rounded  corners ;  a  cross  partition  divides  it  in  2  compartments, 
for  3  days'  rations  of  coffee  and  sugar;  the  ends  are  closed  with 
screw  covers.  The  screw  cover  on  the  sugar  compartment  has  a 
round  receptacle  2  inches  in  diameter,  y2  inch  deep,  closed  with  a 
compression  friction  top,  for  carrying  3  days'  rations  of  salt.  (See 
Haversack,  p.  465.) 

In  the  field,  bacon,  in  the  absence  of  fresh  meat,  becomes  an  in- 
valuable component  of  the  ration,  easily  kept  and  transported,  read- 
ily digested  when  well  cooked,  and  furnishing  abundant  energy  for 
severe  muscular  work. 


388 


MILITARY    HYGIENE. 


In  the  field,  a  quarter  ounce  of  soap  per  ration  is  also  issued  (in 
ounce  cakes.) 

Existing  orders  prescribe  that  one  day  in  each  alternate  month  of 
the  season  of  practical  instruction,  not  exceeding  three  days  in  each 
year,  the  use  of  the  reserve  ration,  with  individual  mess-kit,  will 
be  required  of  all  troops  in  the  field  for  purposes  of  instruction. 

IV.  Field  Ration. 

The  field  ration  is  the  ration  prescribed  in  orders  by  the  com- 
mander of  the  field  forces.  It  consists  of  the  reserve  ration  in 
whole  or  in  part,  supplemented  by  articles  of  food  requisitioned 
or  purchased  locally,  or  shipped  from  the  rear,  provided  such  sup- 
plements or  substitutes  correspond  generally  with  the  component 
articles  or  substitutive  equivalents  of  the  garrison  ration. 

V.  Filipino  Kation. 

Issued  to  the  Philippine  scouts  (Philippine  Islands). 


Component  articles  and  quantities 

Substitutive  articles  and  quantities 
in  ounces 

Beef,  fresh  

12        OZ. 

8      oz. 

.32  oz. 

20       oz. 
8      oz. 

I          OZ. 
2         OZ. 

.08  gill 
.64  oz. 

.02  OZ. 

f  Bacon  

o 

12 
12 
8 

8 
8 

J  Canned  meat   

Flour   

]  F,ish,  canned  

[  Fish,   fresh   

}  Hard  bread  

Baking  powder,  when  in  field 
and  ovens  are  not  available. 
Rice    unpolished   

|  Soft  bread  

Onions  

Potatoes    

Coffee,  roasted  and  ground.. 
Sugar    

.  1 

Vinegar  

Salt   

Pepper,  black  

The  components  of  the  ration  yield  a  maximum  fuel  value  of 
3,980  calories. 

As  is  well  known,  Filipinos,  like  other  Oriental  races,  manifest  a 
marked  preference  for  rice,  to  the  exclusion  of  more  nutritious 
food,  thereby  rendering  themselves  liable  to  beriberi  (which  see). 
To  guard  the  scouts  against  such  possibility,  it  is  prescribed  that 
only  unpolished  rice  will  be  issued  to  them  and  that  no  more  than 


THE   RATION.  389 

16  ounces  per  day  will  be  used.  They  are  also  required  to  use  the 
entire  meat  allowance.  For  the  portion  of  the  rice  ration  not 
drawn,  1.6  ounces  of  beans  are  substituted,  while  native  products, 
such  as  camotes,  mongos  and  squash,  are  utilized  to  as  large  an  ex- 
tent as  possible. 

VI.  Emergency  Ration. 

"  The  emergency  ration  is  furnished,  in  addition  to  the  regular 
ration,  as  required  for  troops  on  active  campaign  or  in  the  field  for 
purposes  of  instruction,  and  will  not  be  opened  except  by  order  of 
an  officer,  or  in  extremity,  nor  used  when  regular  rations  are 
obtainable." 

The  emergency  ration  used  in  our  service,  prior  to  1910,  weighed 
12  ounces  net  and  consisted  of  wheat,  meat,  chocolate  and  seasoning. 
Its  preparation  was  so  elaborate  as  to  require  special  plants  so  that, 
in  case  of  mobilization  on  a  large  scale,  the  supply  would  have  been 
inadequate.  The  components  of  the  present  ration  are  such  as  to 
be  readily  obtained  and  prepared  to  any  extent  needed.  They  are 
as  follows :  • 

Chocolate  liquor,  4545  per  cent. 

Nucleo-casein,  7.25     "     " 

Malted  milk,  7.25     "     " 

Egg  albumen,  14.55     "     " 

Powdered  cane  sugar,  21.82     "     " 

Cocoa  butter,  3.64     "     " 

Their  chemical  analysis  shows: 

Protein,  2S-24  Per  cent. 

Amino-bodies,  .88     "     " 

Fat,  28.05     "     " 

Carbohydrates,  39.  n     "     " 

Caffein  and  theobromin,  .17 

Ash,  3.27    "     " 

Each  ration  weighs  8  ounces  net  and  is  put  up  in  3  cakes  of  equal 
size,  each  cake  wrapped  in  tinfoil  and  all  three  inclosed  in  a  her- 
metically sealed  and  lacquered  round-cornered  tin,  with  key-opening 
attachment.  Its  fuel  value  is  1,272  calories,  and  its  cost  40  cents. 

From  previous  experiments  it  is  believed  that  this  ration  can  be 
kept  in  store,  even  in  the  tropics,  for  several  years  without  loss  or 
deterioration.  As  a  compact  and  portable  food  preparation,  in- 
tended to  tide  over  a  day  or  two  until  regular  supplies  are  available, 


390 


MILITARY    HYGIENE. 


it  is  undoubtedly  well  adapted  to  its  purpose.  However,  there  is 
serious  doubt  of  its  necessity,  and  the  Infantry  Equipment  Board 
of  1912  recommended  that  it  be  abolished  and  replaced  by  the  re- 
serve ration. 

The  "  Trail  Ration,"  for  use  in  Alaska  only,  is  the  garrison  ration 
with  an  increase  in  the  allowance  of  beans,  potatoes,  coffee,  sugar, 
sirup  and  butter. 


THE  RATION  OF  THE  UNITED  STATES  NAVY. 
This  ration  consists  of  the  components  embraced  under  i,  2  and  3, 
and  of  a  weekly  allowance  of  other  articles  as  enumerated  below. 


Component   articles    and   quantities 


Salt  or  smoked  meat 20  oz. 

Fruit,  dried  6  oz. 

or  canned  or  preserved.  6  oz. 

Flour 12  oz. 

or  beans  or  peas 3  gills 

Preserved  meat  16  oz. 

Fruit,  dried  3  oz. 

or  canned  or  preserved.  6  oz. 

Rice 8  oz. 

or  canned  vegetables ...  12  oz. 

or  desiccated  vegetables.  6  oz. 

f  Biscuit 16  oz. 


Butter 2  oz. 

Sugar 4  oz. 

Coffee  or  cocoa 2  oz. 

or  tea $  oz. 

with   condensed  milk  or 

evaporated  cream  ....  i  oz. 
WEEKLY  : 

Macaroni 4  oz. 

Cheese . .  4  oz. 

Tomatoes 4  pz. 

Vinegar  or  sauce \  pint 

Pickles i  pint 

Molasses \  pint 

Salt 4  oz. 

Pepper \  oz. 

Spices i  oz. 

Dry  mustard   i  oz. 

Lard  or  suitable  substitute...  7  Ibs. 
Yeast     and     flavoring     extracts     as 
necessary. 


Substitutes   when   deemed   necessary 
by  the   senior  officer  present 


Fresh  meat  or  fresh  fish..  28  oz. 
or  8  eggs. 

I  Fresh  vegetables  .........  28  oz. 

J 

Fresh  meat  or  fresh  fish.  .  28  oz. 
or  8  eggs. 


Fresh  vegetables  .........   28  oz. 


Soft  bread  20  oz. 

or  flour  .  .    18  oz. 


for  every  100  Ibs.  of  flour  issued  as 
bread. 


THE   RATION. 


391 


The  following  substitutes  can  likewise  be  issued  when  authorized  by  the 
senior  officer  present. 


For 


Beans  or  peas 3  gills 


Condensed  milk  or  evaporated 

cream i    Ib. 

Dried  fruit 3  oz. 

Canned  or  preserved  fruit 6  oz. 

Flour 12  oz. 

Rice  or  other  starched  food..  8  oz. 

Canned  vegetables  12  oz. 

Macaroni 4  oz. 

Cheese 4  oz. 

Vinegar  or  sauce i  pint 

Pickles i  pint 

Molasses i  pint 

Spices i  oz. 


Substitute 


Flour 12  oz. 

or  rice 8  oz. 

or  other  starched  food 8  oz. 

or  canned   vegetables 12  oz. 


Fresh  milk  i  quart 

Fresh  fruit Q  oz. 

Fresh  fruit 9  oz. 

Beans  or  peas 3  gills 

Beans  or  peas 3  gills 

Beans  or  peas 3  gills 

Sugar 3  Ibs. 

or  condensed  milk ii  Ibs. 

or  coffee  i    Ib. 

or  canned  fruit lilbs. 

or  canned  vegetables 4  Ibs. 

j  or  flour 4  Ibs. 


An  extra  allowance  of  one  ounce  of  coffee  or  cocoa,  two  ounces 
of  sugar,  four  ounces  of  hard  bread  or  its  equivalent,  and  four 
ounces  of  preserved  meat  or  its  equivalent  are  allowed  to  enlisted 
men  of  the  engineer  and  dynamo  force  who  stand  night  watches 
between  8  o'clock  postmeridian  and  8  o'clock  antemeridian,  under 
steam. 

This  ration  provides  a  great  variety  of  foodstuffs  and  condiments 
and  permits  almost  any  substitutes  so  as  to  give  it  perfect  adapt- 
ability to  all  climatic  conditions.  It  is  only  open  to  the  criticism 
that,  in  quantity,  it  is  manifestly  in  excess  of  requirements,  and  that 
its  issue  may  be  attended  with  serious  risks  of  overfeeding  and 
waste. 

THE    RATION   IN    FOREIGN    ARMIES. 

France.  —  In  France,  four  types  of  rations  are  provided,  two  for 
peace  (garrison  ration  and  maneuver  ration)  and  two  for  war  (or- 
dinary and  large  field  rations). 

Their  components  are  as  follows; 


392 


MILITARY    HYGIENE. 


Article 


Soft  bread  (brown) 

Soup  bread  (white) 

Fresh  beef  

Rice 

or  pulses  

Lard 

or  beef  suet  

Salt 

Sugar  

Coffee 


Garrison  ration 

Ordinary 
field  ration 

Large 
field  ration 

Kg.  Grams 

Kg.  Grams 

Kg.  Grams 

0.750 
0.250 

0.750 

0.750 

0.320 
0.030 
0.060 

0.400 
0.060 
0.060 

0.500 

O.IOO 
O.IOO 

0.030 

0.030 

0.030 

0.040 
0.016 

0.040 

O.O2O 

0.040 

0.02O 

O.O2I 

0.016 

0.021 

0.016 

0.031 
0.024 

The  soft  bread  ("pain  de  munition")  is  a  leaven-made  bread 
from  flour  bolted  to  20  per  cent. ;  it  may  be  replaced  by  pain  bis- 
cuite  (page  356)  or  by  hard  bread  and  partly  by  Italian  pastes  and 
flours  of  cereals ;  the  beef,  by  any  kind  of  fresh  or  preserved  meat, 
fish,  cheese  or  milk;  the  rice  and  pulses,  by  any  available  dry  or 
green  vegetables. 

In  bivouac,  or  whenever  ordered  by  the  commanding  general  in 
the  field,  a  liquid  ration  is  issued  of  either  wine  (y2  pint),  beer  (i 
pint)  or  brandy  (2  oz). 

The  garrison  ration  contains  (according  to  R'ouget  and  Dopter}  : 
Proteins  125.06  grams,  yielding     5 13  calories. 

Fats,  60.46  grams,  yielding     562  calories. 

Carbohydrates,       573.52  grams,  yielding  2,351  calories. 


Total, 


3,426  calories. 


The  maneuver  ration  contains  less  protein  and  fat,  having  a  fuel 
value  of  3,164  calories. 

The  ordinary  field  ration  contains : 

Proteins,  123.60  grams,  yielding     507  calories. 

Fats,  64.74  grams,  yielding     602  calories. 

Carbohydrates,       476.99  grams,  yielding  1,956  calories. 


Total, 


3,065  calories. 


Soup  bread  may  be  added  if  available  (which  is  seldom  the  case), 
increasing  the  total  calories  to  3,687. 

The  fuel  value  of  the  large  field  ration  (without  soup  bread)  is 
3,383  calories. 


THE   RATION.  393 

The  French  soldier  takes  two  meals  a  day,  breakfast  at  10  A.  M. 
and  dinner  at  5  p.  M.,  besides  black  coffee  at  reveille. 

In  time  of  peace,  the  commissary  department  supplies  only  hard 
bread,  sugar  and  coffee,  as  well  as  wine  and  brandy  when  authorized. 
The  rest  of  the  ration  is  purchased  by  the  company  messes  ("  or- 
dinaires ")  from  special  money  allowances  (about  10  cents  per 
man),  under  the  supervision  of  a  council  appointed  by  the  com- 
manding officer  ("  commission  des  ordinaires  ").  Money  allowances 
remaining  unexpended,  that  is,  resulting  from  savings  on  the  ration, 
cs  well  as  proceeds  from  fines,  sale  of  wastes,  etc.,  are  used  in  pur- 
chasing such  additional  articles  of  food  as  deemed  desirable. 

In  war,  the  men  carry  two  days'  rations  in  the  haversack;  two 
more  are  carried  in  the  regimental  trains  and  four  on  the  adminis- 
trative trains. 

Germany.  — •  In  Germany,  four  types  of  rations  are  also  provided, 
two  for  peace  time  and  two  for  the  field.  The  large  peace  ration, 
such  as  issued  during  maneuvers,  consists  of  750  grams  of  bread, 
or  500  of  field  biscuit,  or  400  of  egg  biscuit ;  250  grams  of  'fresh 
meat,  with  60  of  kidney  fat,  or  200  of  smoked  bacon,  or  200  of 
canned  meat;  and  vegetables.  According  to  Bischoff  its  composi- 
tion is:  protein,  89.9  grams;  fats,  80.7;  carbohydrates,  514.8;  with 
fuel  value  of  3,230  calories. 

The  other  peace  ration  is  somewhat  smaller  and,  in  certain  gar- 
risons, has  to  be  supplemented  from  the  private  means  of  the  sol- 
dier. The  small  field  ration  averages  141  grams  of  protein,  51  of 
fat  and  458  of  carbohydrates,  with  fuel  value  of  2,929  calories ;  the 
large  field  ration,  181  grams  of  protein,  64  of  fat  and  558  of  carbo- 
hydrates, with  fuel  value  of  3,625  calories. 

The  commissary  furnishes  bread  and  meat,  most  of  the  other 
articles  being  purchased  out  of  a  daily  allowance  of  4  cents  per  man. 

The  German  soldier  takes  a  cup  of  black  coffee,  or  coffee  with 
milk,  and  bread  in  the  morning,  dinner  at  noon  and  a  light  supper 
in  the  evening.  During  maneuvers,  or  in  the  field,  he  may  also  re- 
ceive i  quart  of  beer,  i  pint  of  wine  or  about  3  ounces  of  spirits. 

Great  Britain.  —  The  ration  of  the  British  soldier,  in  garrison,  con- 
sists of  16  ounces  of  bread,  12  ounces  of  meat,  and  such  additional 
articles  (vegetables,  groceries)  as  are  purchased  out  of  a  daily  al- 
lowance of  7  cents.  During  maneuvers  the  meat  is  increased  to  16 
ounces. 

In  the  field,  his  ration  varies  according  to  climate  and  the  char- 


394  MILITARY    HYGIENE. 

acter  of  his  work;  it  generally  consists  of  16  ounces  of  salted  or 
preserved  meat,  or  16  to  20  ounces  of  fresh  meat ;  20  ounces  of  fresh 
bread  or  16  ounces  of  hard  bread  or  flour ;  i  ounce  of  compressed 
vegetables,  or  8  ounces  of  potatoes  (or  other  fresh  vegetables),  or 
2  ounces  of  rice  (or  split  peas),  or  4  ounces  of  onions;  coffee,  tea 
or  chocolate,  sugar  and  the  usual  condiments.  Two  ounces  of 
spirits  and  some  tobacco  may  also  be  allowed. 

An  emergency  ration  is  provided  in  the  British  Army,  for  use  only 
when  no  other  food  is  procurable  and  when  authorized  by  the  com- 
manding officer.  It  is  contained  in  a  flat  can  and  consists  of  choco- 
late, sugar  and  protein  in  the  form  of  "  plasmon,"  weighing  6y2 
ounces  net.  According  to  Langworthy,  its  proximate  principles 
average :  protein  59  grams,  fat  50  and  carbohydrates  65,  with  fuel 
value  of  973  calories.  This  ration,  like  our  own  emergency  ration, 
is  relatively  too  rich  in  protein  and  deficient  in  carbohydrates. 

Russia.  —  The  Russian  soldier,  in  the  field,  receives  2*4  pounds  of 
black  bread  (from  unbolted  rye  flour),,  14^2  ounces  of .  fresh  meat 
or  1 1  of  preserved  or  salt  meat,  9  ounces  of  green  vegetables  or  the 
equivalent  in  compressed  vegetables,  i  to  2  ounces  of  suet  or  butter 
for  cooking,  together  with  4  to  5  ounces  of  grits,  tea>  sugar  and 
condiments. 

According  to  Bischoff  its  composition  is :  protein,  120.7  grams ; 
fat,  39.2;  carbohydrates,  628;  with  fuel  value  of  3,147  calories. 

Most  of  the  articles  of  the  ration  (bread  excepted)  are  boiled  to- 
gether in  a  large  wheeled  kettle  and  served  as  soup  (see  page  379). 
Japan.  —  The  Japanese  ration,  in  the  field,  consists  of: 
Rice,  uncooked,  30  ounces. 

or  steamed  and  dried,  25  ounces, 
or  fresh  bread,  20  ounces 
or  hard  bread,  13  ounces. 
Meat,  canned,  10  ounces. 

or   fresh    (with   bones)    13   ounces    (which   may  be   in- 
creased to  20  if  procurable). 
or  salt,  dry  or  smoked  meat,  8  ounces. 
or  fish. 
Vegetables,  dry,  8  ounces. 

or  green,  32  ounces. 
Pickles,  sauces  and  condiments. 
Tea  and  sugar. 
Sake  (beer  made  from  rice). 


THE   RATION.  395 

The  Japanese  soldier  does  not  take  readily  to  bread,  either  fresh 
or  hard.  During  the  Russo-Japanese  War,  the  meat  component  was 
scant  and  issued  irregularly;  rice,  fish  and  vegetables  formed  the 
staple  ration. 

The  Japanese  medical  regulations  provide  that  the  nutritive  value 
of  the  ration  should  never  fall  below  2,580  calories. 

EMERGENCY  RATION.  —  All  foreign  armies  have  a  so-called 
emergency  ration,  but,  with  the  exception  of  England,  it  is  nothing 
else  but  a  field  ration  in  a  more  condensed  and  portable  form,  con- 
sisting of  hard  bread,  and  preserved  meat  and  vegetables  in  cans. 


CHAPTER  XXXI. 

CONCLUSIONS  REGARDING  THE  COMPOSITION  AND  FOOD 
VALUE  OF  THE  MILITARY  RATION. 

In  a  previous  chapter  it  was  stated,  on  good  grounds,  that  an  adult 
man  weighing  154  pounds  is  in  better  physical  condition,  stronger 
and  capable  of  greater  endurance,  with  a  ration  yielding  2,800 
calories,  especially  if  the  proteins  are  kept  within  a  maximum  of  60 
grams,  than  with  one  greatly  exceeding  this  value.  But  we  have 
seen  that  in  our  service,  as  in  all  other  leading  countries,  the  sol- 
dier's ration  exceeds  these  limits  in  the  number  of  calories  which 
range  from  3,000  to  5,000,  but  especially  in  the  amount  of  proteins 
(Japanese  excepted)  which  hardly  ever  falls  below  100  and  often 
ranges  up  to  160  or  more  grams.  There  is  no  indication  therefore 
that,  in  this  country  or  in  Europe,  the  soldier  is  underfed,  provided 
he  actually  receives  the  ration  called  for  by  military  regulations. 

Much  has  been  written  on  the  necessity  of  feeding  the  soldier 
well,  and  much  attention  and  study  have  been  devoted  to  the  com- 
position of  adequate  rations.  That  he  should  be  sufficiently  and 
properly  fed  needs  no  discussion,  but  the  belief  generally  entertained 
that  the  more  he  eats  the  greater  is  his  energy  and  efficiency  is 
groundless  and  mischievous.  The  danger  of  overeating  has  been 
too  much  overlooked,  or  else  esteemed  a  negligible  factor.  It  is 
the  opinion  of  many  careful  observers  that  the  American  soldier  is 
much  more  likely  to  be  overfed  than  underfed,  and  that  his  health 
and  efficiency  stand  in  greater  peril  from  excess  than  from  lack  of 
food.  As  a  general  rule,  the  soldier  does  not  know  how  to  regulate 
his  appetite,  nor  does  he  appreciate  the  necessity  of  doing  so.  He 
eats  what  is  allowed  him  hurriedly  and  often  without  proper  mastica- 
tion, and,  between  meals,  frequently  patronizes  the  lunch  counter 
of  the  post  exchange  or  the  outside  shop  where  pies  and  other  tempt- 
ing pastry  are  displayed.  This  is  characteristic  of  the  soldiers  of 
all  countries,  particularly  of  those  who  receive  the  most  liberal  ra- 
tions. Thus  the  remarks  of  Rouget  and  Dopter,  in  their  "  Hygiene 
militaire,"  although  aimed  at  their  countrymen,  are  of  very  general 

396 


CONCLUSIONS    REGARDING   THE    MILITARY    RATION.  397 

application.  °l  Many  Frenchmen,  especially  in  the  country,  have  the 
pernicious  habit  not  to  cease  eating  until  they  experience  a  sensation 
of  fullness  in  the  stomach.  Little  do  they  care  about  the  nutritive 
value  of  the  food  ingested.  Their  conviction  is  that,  so  long  as  this 
abdominal  repletion  is  not  distinctly  felt,  they  have  not  been  suffi- 
ciently fed.  This  is  particularly  observed  each  year  at  the  time  of 
the  incorporation  of  the  new  contingent.  The  amount  of  bread  in 
the  ration,  although  considerable,  is  not  enough  to  satiate  these 
young  soldiers ;  they  buy  more  from  outside  bakeries." 

It  should  be  remembered  that  within  an  hour  or  two  after  taking 
a  full  meal,  at  least  a  pint  of  gastric  juice  is  poured  into  the  stomach 
and  added  to  its  contents,  so  that  what  was  at  first  mere  repletion 
may  become  uncomfortable  distention.  Soldiers  should  be  advised 
that  a  sensation  of  fullness  or  distention  following  a  meal  is  a  clear 
admonition  that  they  have  eaten  too  much,  and  that  if  such  excess 
is  kept  up,  as  a  habit,  they  will  surely  suffer  in  health  and  efficiency. 
Such  advice  may  do  good,  but  more  practical  results  will  follow  if 
the  food,  especialy  the  meat,  as  served  in  the  mess-room,  is  simply 
sufficient  and  not  wastefully  abundant. 

Experience  shows  that  it  is  while  actively  engaged  in  the  field, 
when  the  rations  are  reduced  and  the  cooking  simple,  that  the  men 
enjoy  the  best  health  and  show  most  endurance,  provided,  of  course, 
there  is  no  actual  lack  of  food.  Thus,  during  the  active  part  of 
the  Santiago  campaign,  in  1898,  there  was  but  little  sickness  in  spite 
of  the  trying  climate  and  of  short  commissary  supplies,  but  as  soon 
as  the  work  was  over  and  rations  became  abundant,  the  morbidity 
began  to  rise  and  before  long  exceeded  75  per  cent,  of  the  command. 
It  is  hard  to  resist  the  conviction  that  injudicious  feeding  was  re- 
sponsible for  many  of  the  cases  of  "  undetermined  fever,"  and  pre- 
pared the  way  for  much  of  the  malaria  which  prevailed  in  our  camps 
near  Santiago,  as  well  as  of  the  typhoid  fever  which  decimated  our 
troops  in  the  United  States.  It  is  noteworthy  that  the  Spanish  sol- 
diers in  Santiago,  although  reduced  to  very  scant  rations  of  poor 
quality,  had  a  much  smaller  proportion  of  sick  than  the  American 
troops.  During  the  Boer  War,  in  South  Africa,  the  English  troops 
besieged  in  Lady sm ith .  were  fed  for  several  months,  according  to 
Dunlop,  on  a  ration  of  73  grams  of  protein,  69  of  fat  and  141  of  car- 
bohydrates, with  fuel  value  of  only  1,527  calories,  but  which,  as  re- 


398  MILITARY    HYGIENE. 

marked  by  Munson,  furnished  energy  enough  for  a  stout  and  suc- 
cessful resistance.  The  Russo-Japanese  War  has  taught  us  an  im- 
portant lesson  in  dietetics.  Both  Russians  and  Japanese  had  meat 
rations  much  smaller  than  those  provided  for  American,  English 
and  French  soldiers ;  the  meat  ration  of  the  Japanese,  in  particular, 
was  decidedly  meagre  and  often  lacking  altogether.  Yet  we  know 
that  no  armies,  during  an  arduous  war  of  twenty  months,  ever  suf- 
fered so  little  from  infectious  diseases  and  had  fewer  men  incapaci- 
tated from  sickness.  To  what  extent  this  immunity  is  due  to  the 
food  can  only  be  conjectured.  It  certainly  cannot  be  attributed  ex- 
clusively to  the  sanitary  measures  taken,  for  it  was  the  opinion  of 
the  American  and  English  attaches  with  both  armies,  that  had  their 
own  troops  been  placed  under  similar  conditions,  but  fed  with  their 
own  rations,  typhoid  fever  would  undoubtedly  have  prevailed  among 
them  in  an  epidemic  form.  It  is  true  that  the  Japanese  suffered 
much  from  beriberi  during  this  war,  a  disease  known  to  be  due  to 
an  excess  of  rice  combined  with  a  deficiency  of  protein,  but  there  is 
no  doubt  that  it  would  have  been  entirely  prevented  had  the  Japanese 
soldier  received  one-half  of  the  protein  component  called  for  by  the 
ration  of  the  United  States  soldier. 

Surgeon  Tsui,  of  the  Chinese  Army  (Mil  Surg.,  Nov.,  1909), 
states  that,  in  Northern  China,  the  country  laborers  from  whom  the 
army  is  mostly  recruited,  men  of  fine  physique  and  most  remark- 
able power  of  endurance,  live  almost  exclusively  on  a  vegetable 
diet.  The  Chinese  soldier  receives  meat  only  twice  a  month.  The 
rates  of  sickness  and  death  in  the  Chinese  Army,  according  to  this 
trustworthy  authority  are  much  lower  than  in  our  Army. 

It  is  a  well  established  fact  that  the  troops  of  the  belligerent 
armies  in  the  European  War  (1917),  after  several  years  of  arduous 
service,  on  rations  often  necessarily  curtailed  and  indifferently  pre- 
pared, are  hardier,  capable  of  greater  effort  and  more  resistant  to 
disease  than  at  the  beginning  and  during  the  first  year  of  the  war. 

Formerly,  the  price  of  savings  made  from  the  ration  and  paid  by 
the  O.  M.  Corps  to  the  organization  commander,  could  be  expended 
by  the  latter  in  any  way  deemed  most  advantageous  to  the  organ- 
ization, that  is,  not  only  in  the  purchase  of  other  kinds  of  food,  but 
of  any  articles  intended  for  the  comfort  and  enjoyment  of  the  men, 
such  as  games,  sporting  goods,  etc.  Under  existing  regulations, 


CONCLUSIONS    REGARDING   THE    MILITARY   RATION.  399 

money  received  as  balance  of  the  ration  and  savings  account "  can 
be  spent  only  for  food.  It  follows  that  the  company  commander 
has  no  longer  any  discretion  in  regulating  the  amount  of  food  con- 
sumed by  his  men,  but  is  expected  to  expend  the  entire  money  value 
of  the  ration  in  the  purchase  of  foodstuffs.  The  writer  cannot 
commend  this  change.  He  believes  that  the  former  system  whereby 
the  company  commander  was  allowed*  discretion  in  regulating  the 
quantity  as  well  as  the  quality  of  the  food  was  better  calculated  to 
safeguard  the  health  and  comfort  of  his  men. 

As  the  outcome  of  the  latest  study  and  experience  in  the  physiol- 
ogy of  nutrition  among  adult  men,  we  may  state  that,  in  garrison  or 
camp,  the  fuel  value  of  the  ration  actually  consumed  need  not  be 
over  2,800  and  should  never  exceed  3,000  calories,  and  that  there 
must  be  very  few  circumstances  in  the  field,  except  in  a  very  cold 
climate,  when  a  value  of  3,500  calories  is  desirable  or  necessary. 
Half  a  pound  of  beef,  when  freed  from  bones  and  other  waste,  is 
reduced  to  about  six  ounces  which,  with  the  proteins  of  other  food- 
stuffs of  the  ration,  exceeds  the  60  grams  we  have  seen  to  be  quite 
sufficient  for  the  daily  needs  of  the  active  body.  It  is  therefore 
unphysiological,  wasteful  and  against  the  best  interest  of  the  soldier 
and  of  the  service  to  give  him,  while  in  garrison  or  camp,  much 
more  than  that  amount  of  beef  or  its  equivalent  of  other  meats,  nor 
is  it  necessary  in  the  field  to  exceed  one  pound.  The  solicitude 
of  all  officers  concerned  should  not  be,  how  to  increase  a  ration  al- 
ready extremely  liberal,  but  to  make  it  comprise  as  many  com- 
ponents as  possible,  to  see  that  these  components  are  most  advan- 
tageously combined  to  secure  variety,  that  they  are  cooked,  seasoned 
and  served  in  the  most  digestible  and  appetizing  manner,  and  that 
the  men  be  made  to  understand  the  advantages  of  thorough  mastica- 
tion. In  the  field,  or  wherever  a  desirable  variety  of  food  cannot 
be  obtained  from  the  Q.  M.  Corps,  every  effort  should  be  made  to 
convert  part  of  those  components  allowed  in  excess,  especially  meats 
and  fats,  into  lighter  and  healthier  articles,  according  to  what  local 
markets  afford. 


CHAPTER  XXXII. 

THE  RATION  OF  THE   UNITED   STATES   SOLDIER  IN   THE 

TROPICS. 

(See1  Service  in  Warm  Climates.} 

The  climatic  conditions  characteristic  of  the  tropics  are  a  constant 
high  temperature  and  great  relative  humidity.  The  effects  of  these 
conditions  upon  the  body,  so  far  as  food  is  concerned,  may  be  stated 
thus: 

1.  Increased  bodily  temperature   (half  degree  or  more  until  ac- 
climation is  established)    from  diminished  loss  of  heat  by  radia- 
tion, convection  and  evaporation. 

2.  Loss  of  flesh,  especially  of  fat,  so  that  the  normal  weight  is 
reduced  several  pounds. 

3.  Decreased  oxygenation,  from  the  expansion  and  rarefaction  of 
the  air  and  lower  atmospheric  pressure. 

4.  Greatly  increased  perspiration,  causing  a  diminution  of  urine 
and  of  the  digestive  fluids. 

5.  General  depression  of  the  nervous  system  and  loss  of  vital 
energy,  with  weakening  of  the  digestive  and  assimilative  functions, 
as  well  as  diminished  power  of  mental  applicaton  and  muscular 
acton. 

Let.  us  remember  that  food  is  the  fuel  which  generates  animal 
heat,  and  that  it  must  be  constantly  supplied  in  order  to  maintain 
the  normal  temperature  of  the  body  and  furnish  the  necessary 
mental  and  muscular  energy.  The  body  temperature  of  98.6°  is  a 
constant  term,  admitting  of  only  slight  variations,  but  the  rate  of 
heat  dissipation  is  variable  and  depends  chiefly  upon  atmospheric 
conditions.  This  dissipation  takes  place  mostly  through  radiation 
and  evaporation.  The  smaller  it  is,  the  less  food  will  be  required 
to  maintain  the  body  at  its  normal  temperature.  As  the  air  tem- 
perature increases  and  approximates  that  of  the  body,  the  rate  of 
outward  radiation  decreases ;  but,  if  the  warmer  air  be  also  drier, 
the  diminished  radiation  may  be  offset  by  increased  evaporation,  so 

400 


THE  RATION  OF  THE  UNITED  STATES   SOLDIER   IN   THE  TROPICS.         4OI 

that  the  loss  of  heat  remains  about  the  same.  It  is  only  in  climates 
both  warm  and  damp,  such  as  are  found  in  tropical  and  subtrop- 
ical latitudes,  that  the  loss  of  heat  from  the  body  is  more  or  less 
permanently  lessened,  both  by  radiation  and  evaporation.  It  is 
therefore  in  such  climates  that  the  amount  of  food  should  be  cor- 
respondingly diminished  in  order  to  avoid  the  discomfort  and  danger 
of  a  greater  evolution  of  heat  than  can  be  disposed  of  by  the  system. 

Besides  the  fuel  value  of  food,  as  measured  by  calorimetric  com- 
bustion, there  is  another  source  of  heat  which  should  not  be  over- 
looked, what  has  been  called  the  "  specific  dynamic  action  "  of  food. 
This  is  the  result  of  the  increased  metabolism  caused  by  the  activity 
of  the  digestive  organs  in  the  processes  of  mastication,  digestion  and 
absorption.  It  is  well  marked  within  an  hour  of  eating,  and  steadily 
increases  during  the  next  2  or  3  hours.  It  is  greatest  after  the  in- 
gestion  of  proteins,  less  with  carbohydrates  and  least  with  fats,  in 
the  proportion  of  20,  10  and  7.  According  to  Rubner,  the  evolu- 
tion of  heat  may  thus  be  rapidly  increased  by  rich  feeding  to  the 
extent  of  44  per  cent. 

The  normal  physiological  amount  of  food  required  for  the  needs 
of  the  body  is  smaller  in  the  tropics  than  in  temperate  regions. 
Man,  there,  is  not  capable  to  absorb  and  assimilate  the  same  quan- 
tity, nor  has  he  the  same  craving  for  it.  The  loss  of  heat  from  the 
body  being  smaller,  less  fuel  is  needed  to  maintain  the  temperature 
required  for  the  performance  of  all  its  functions.  The  decreased 
oxygenation  is  an  important  factor  in  considering  the  question  of 
alimentation  in  the  tropics ;  the  constructive  and  destructive  metab- 
olism of  tissues  depends  chiefly  on  the  amount  of  available  oxygen 
present,  and  food  is  useless  or  detrimental  which  for  want  of  it  can- 
not be  converted  into  assimilable  bodies  or  else  broken  up  and  elim- 
inated. The  loss  of  weight,  the  weakened  power  of  digestion  and 
assimilation,  the  diminished  physical  vigor  and  muscular  exertion, 
are  so  many  reasons  for  a  corresponding  reduction  in  the  diet.  In- 
creased perspiration  diminishes  the  amount  of  urine  and  output  of 
urea,  so  that  more  work  is  thrown  upon  the  liver  and  skin  as  ex- 
cretory organs.  Unless  the  food  is  suitably  adjusted  to  the  new 
conditions,  there  is  danger  of  hepatic  congestion,  with  subsequent 
inflammation  and  degeneration,  as  frequently  seen  in  hot  climates. 

These  theoretical  considerations  are  confirmed  by  the  established 


4O2  MILITARY    HYGIENE. 

dietary  habits  of  people  living  at  different  latitudes ;  in  other  words, 
we  find  that  the  nutritive  amount  of  food  consumed  by  the  same 
class  of  laborers  diminishes  as  we  advance  from  the  northern  por- 
tion of  the  temperate  zone  to  the  tropics.  Thus  the  Department  of 
Agriculture  (Bull.  38  and  71)  has  shown  that  while  negro  families 
in  northern  Virginia  consume  109  grains  of  protein,  159  of  fats  and 
444  of  carbohydrates,  with  fuel  value  of  3,745  calories,  families  of 
the  same  class  in  southern  Alabama  only  consume  62  grains  of 
protein,  132  of  fats  and  436  of  carbohydrates,  with  fuel  value  of 
3,012  calories.  The  fuel  value  of  the  food  consumed  by  the  natives 
of  all  tropical  countries  is  estimated  to  range  from  2,000  to  3,000 
calories. 

Admitting  that  a  reduction  of  the  soldier's  ration,  as  adjusted  for 
temperate  climates,  is  necessary  in  the  tropics,  the  next  question  is 
in  which  of  the  proximate  principles  should  it  be  made;  undoubt- 
edly in  the  fats  and  proteins. 

Fats  are  only  digestible  to  a  limited  extent,  according  to  the  needs 
of  the  body.  When  taken  in  excess  they  are  extremely  apt  to  split 
up  in  the  stomach  into  irritating  acids  which,  together  with  hepatic 
congestion  and  disturbed  bile  secretion,  produce  the  condition  known 
as  biliousness,  often  attended  with  putrefaction  of  the  intestinal 
contents  and  catarrhal  inflammation  of  the  bowels.  As  fats  con- 
tain but  little  oxygen,  they  are  often  unable  to  obtain  the  large 
amount  of  it  required  for  their  complete  combustion,  thus  becom- 
ing an  incubus  in  the  system ;  on  the  other  hand,  if  completely  me- 
tabolized they  evolve  much  more  heat  than  is  desirable.  It  is  not 
contended  that  all  fats  should  be  banished  from  the  tropical  ration ; 
a  certain  amount  is  necessary,  but  this  should  be  very  moderate  and 
in  the  most  acceptable  form.  Vegetable  oils  have  been  recom- 
mended. The  butter  accompaniment  of  the  daily  bread,  if  not  en- 
tirely left  out,  should  be  reduced  to  a  minimum.  Bacon,  when  well 
cooked  so  as  to  be  dry  and  granular,  is  quite  acceptable  even  in  hot 
countries 

The  reasons  before  urged  for  a  reduction  of  proteins  in  tem- 
perate zones  apply  with  still  greater  force  in  the  tropics,  where  the 
digestive  functions,  oxygenation,  metabolism  and  elimination  are 
more  or  less  impaired.  The  amount  of  proteins  which  is  digested 
and  utilized  in  a  temperate  zone  may  here  overload  the  system  with 


THE  RATION  OF  THE  UNITED  STATES   SOLDIER   IN   THE  TROPICS.         403 

unoxidized  nitrogenous  waste,  or  else,  if  oxidized  and  discharged 
by  the  kidneys  as  urea,  strain  these  organs  already  functionally 
weakened  by  a  diminished  excretion  of  urine.  Proteins,  although 
reduced  in  quantity,  should  be  as  varied  and  digestible  as  possible. 
Beef  can  be  now  and  then  replaced  by  mutton,  often  by  fresh  fish, 
which  is  always  good  and  abundant  in  the  tropics,  while  eggs, 
cheese,  beans  (frijoles)  and  macaroni  will  also  help  in  furnishing 
the  necessary  nitrogen  in  acceptable  forms.  Fish  is  often  objected 
to  by  the  company  cook  and  left  out  of  the  men's  dietary  simply  be- 
cause of  the  trouble  in  preparing  it,  a  striking  instance  of  the  indif- 
ference of  some  company  commanders  in  the  discharge  of  one  of 
their  most  important  duties. 

All  authors  agree  that,  in  the  tropics,  carbohydrates  should  form 
the  best  part  of  the  dietary.  They  are  the  most  easily  oxidized  of 
the  proximate  principles,  the  most  readily  metabolized  and  elimi- 
nated, their  decomposition  products  being  simply  aqueous  vapor  and 
carbon  dioxid. 

The  natives  of  tropical  regions  obtain  their  food  almost  entirely 
from  the  vegetable  kingdom,  consisting  chiefly  of  bread,  rice,  beans, 
vegetables,  fruit,  coffee  and  sugar,  to  which  poultry,  eggs  and  fish 
are  occasionally  added ;  hence  the  natural  inference  that  this  diet 
is  likewise  the  best  adapted  to  the  needs  of  white  people  in  the 
tropics.  Such  an  inference,  correct  in  the  main,  needs  to  be  quali- 
fied ;  the  natives  did  not  consciously  select  their  diet ;  as  a  rule,  they 
are  ignorant,  indolent  and  poor,  and  therefore  consume  the  food 
procured  with  the  least  effort  and  expense.  There  is  no  doubt,  how- 
ever, that  this  food,  which  is  mostly  that  provided  by  nature,  is  the 
best  for  them ;  its  chief  defect  is  a  lack  of  variety.  As  soon  as  they 
can  afford  it  they  are  but  too  apt  to  buy  the  viands  and  more  ap- 
petizing foods  of  the  higher  classes,  thereby  losing  their  native  im- 
munity to  various  infectious  diseases  and  becoming  liable  to  the  ills 
of  those  whites  who  neglect  to  adjust  their  habits  to  climatic  con- 
ditions. 

Munson,  in  his  elaborate  study  of  the  subject,*  proposes  several 
dietaries  for  the  soldiers  in  the  tropics,  in  which  the  proteins  vary 
from  123  grams  to  104,  the  fats  from  114  grams  to  10  and  the  car- 
bohydrates from  630  grams  to  517,  with  fuel  value  ranging  from 

*  The  ideal  ration  for  an  army  in  the  tropics,  1900. 


404  MILITARY    HYGIENE. 

2,947  to  3,825  calories.  As  already  seen  from  the  conclusions  drawn 
above,  such  liberal  allowances  cannot  be  accepted  as  representing 
the  actual  amount  of  food  needed  by  the  body  in  the  tropics,  but,  to 
some  extent,  may  be  used  as  the  basis  of  the  ration  to  be  actually 
issued. 

With  our  very  elastic  system  of  supplying  troops,  it  is  not  neces- 
sary to  make  the  tropical  ration  different  from  the  regular  garrison 
ration.  The  money  value  of  the  articles  of  the  ration  not  needed 
can  be  expended  in  purchasing  others  better  adapted  to  the  climatic 
requirements.  Care,  however,  should  be  taken  that  such  liberal 
policy  does  not  engender  wasteful  habits.  The  important  point  to 
determine  is  the  amount  of  proximate  principles  which,  in  the  per- 
formance of  the  ordinary  duties  of  garrison  and  camp,  is  actually 
needed  by  the  men,  to  be  used  as  a  guide  by  the  officers  in  command 
of  organizations,  so  as  to  provide  plenty  and  at  the  same  time  avoid 
overfeeding.  It  has  been  seen  that  this  amount,  in  temperate  zones, 
does  not  exceed  60  grams  of  proteins  and  about  the  same  quantity 
of  fat,  with  enough  carbohydrates  to  yield  a  fuel  value  of  2,800 
calories.  This  then  should  be  the  maximum  for  the  tropics,  to  be 
exceeded  only  in  case  of  unusually  arduous  work.  It  is  furnished 
by  the  following  quantities  of  the  ordinary  components  of  the  ration : 

Articles.  Quantity. 


Fresh  beef,  10  ounces 

or  fresh  mutton,  10  ounces 

or  pork,  6  ounces 

or  bacon,  6  ounces 

or  dried  fish,  10  ounces 

or  fresh  fish,  16  ounces 

Flour,  15  ounces 

or  soft  bread,  15  ounces 

or  hard  bread,  12  ounces 

Beans,  2.4  ounces 

or  peas,  2.4  ounces 

or  frijoles,  2.4  ounces 

or  macaroni  2.4  ounces 

or  rice  4  ounces 


THE  RATION  OF  THE  UNITED  STATES   SOLDIER   IN   THE  TROPICS.         405 

Potatoes,  16  ounces 

or  substitutes,  16  ounces 

Dried  fruit, 

Sugar, 

Coffee, 
or  tea. 

Such  ration  will  yield  at  least  3,000  calories  and,  after  making 
allowances  for  wastes,  comes  up  fully  to  requirements. 

The  best  cereal  and  one  of  the  best  foods  for  tropical  regions  is 
rice ;  therefore  an  effort  should  be  made  to  cook  and  season  it  in  an 
appetizing  manner,  not  boiling  it  into  a  gelatinous,  sticky  mass,  but 
so  that  each  grain,  when  thoroughly  cooked,  stands  unbroken,  sep- 
arate and  dry  (see  page  357). 

As  pointed  out  by  Kean,  it  is  a  blunder  to  make  potatoes  an  indis- 
pensable article  of  the  tropical  ration  and  export  them,  at  great 
trouble  and  expense,  to  our  colonial  possessions  where  native  roots, 
tubers  and  fruits,  at  least  equally  palatable  and  nutritious,  can  be 
readily  obtained.  Potatoes  rapidly  decay  in  transit  or  when  stored 
in  hot  countries,  and  most  of  them  become  unfit  for  use  before  they 
can  be  issued  to  the  companies.  In  the  tropics  it  is  generally  pos- 
sible to  secure  sweet  potatoes,  various  kinds  of  cucurbits  (squash 
family)  and  of  yam,  cassava  (manioca),  taro  (colocasia),  tannier 
(caladium),  etc.,  and  any  number  of  savory  and  palatable  fruits. 
It  should  also  be  made  one  of  the  important  duties  of  the  cook  to 
learn  how  to  prepare  them  for  the  table.  Tropical  fruits,  contrary 
to  popular  prejudices,  if  mature  and  not  over  ripe,  are  all  perfectly 
wholesome. 

In  attempting  to  change  the  quantity  and  quality  of  the  ration  in 
the  tropics,  it  is  well  to  bear  in  mind  the  strong  influence  of  habit. 
The  soldier  going  from  the  United  States  to  our  colonial  possessions 
quickly  understands  the  necessity  of  a  change  in  his  clothing,  but 
is  slow  in  realizing  that  of  a  change  in  his  diet,  and  any  attempt  to 
reduce  too  rapidly  the  quantity  of  food  he  has  been  accustomed  to 
will  be  strongly  resented.  In  this,  as  in  other  things,  he  should  be 
properly  instructed ;  the  advantages  of  such  a  reduction  must 
be  pointed  out  to  him  so  that  he  may  submit  to  it  intelligently  and 
more  completely  appreciate  the  benefits  of  it. 


CHAPTER  XXXIII. 
RULES  TO  BE  OBSERVED  IN  EATING  AND  DRINKING. 

The  general  hygienic  rules  to  be  observed  in  eating  and  drinking, 
in  order  to  maintain  our  best  health,  may  be  summed  up  as  follows : 

1.  Let  the  food  be  simple  but  nutritious  and  varied,  containing 
all  the  proximate  principles  in  suitable  proportion ;  the  digestive  or- 
gans soon  tire  from  the  same  articles  while  they  are  stimulated  by 
change  and  new  combinations.     Highly  seasoned  food,  rich  pastry 
and  savory  cheese  should  be  the  exception,  never  the  rule.   Pungent 
condiments  are  pernicious ;   for  a  while  they   excite  the  digestive 
glands  to  abnormal  action  but  eventually  cause  diminished  secretion 
and  dyspepsia. 

2.  Cook  it  properly  so  as  to  bring  out  its  savors,  promote  a  free 
flow  of  digestive  fluids  and  cause  its  prompt  disintegration  therein. 

3.  Eat  slowly  and  masticate  thoroughly,  for  unless  the  food  is 
properly  cut  and  ground  by  the  teeth,  lumps  of  it  will  escape  the 
action  of  the  saliva  and  gastric  juice,  not  only  remaining  undigested 
but  likely  to  ferment  and  give  trouble. 

4.  Drink  as  much  water  as  may  be  necessary  to  thoroughly  soften 
and  mix  the  food,  but  slowly,  not  too  much  at  a  time,  and  not  too 
cold.     The  old  belief  that  water  should  not  be  drunk  at  meals  on 
the  ground  that  it  hinders  digestion  and  absorption  has  been  proved 
erroneous.     On  the  contrary,  water  promotes  digestion,  especially 
of    fats,   and    insures    more    complete   utilization    of   proteins.      To 
quench  the  thirst,  however,  it  is  best  to  drink  between  meals,  or  be- 
fore beginning  to  eat.     Water  does  not  appear  to  be  absorbed  by 
the  stomach  but  escapes  into  the  intestine,  at  the  rate  of  at  least  a 
pint  an  hour. 

5.  Avoid  dishes  or  beverages  too  hot  or  too  cold,  for  extremes 
of  temperature  check  the  secretion  of  the  gastric  juice,  while  their 
alternations  may  fissure  the  enamel  of  the  teeth.     Water  should  be 
cooled  with  ice,  but  never  ice-cold. 

6.  Observe  regularity  in  the  hours  for  meals,  so  that  the  digestive 
juices  may  be  poured  out  more  abundantly  at  the  accustomed  times. 

406 


RULES  TO   BE   OBSERVED   IN    EATING   AND  DRINKING.  407 

7.  Avoid  over-indulgence  or  intemperance  in  eating,  for  not  only 
does   the   stomach   resent   abuse,   but   the   whole   system   becomes 
clogged  and  the  congested  and  strained  organs  function  imperfectly. 

8.  Do  not  divert  blood  from  the  stomach  during  active  digestion 
by  mental  or  physical  work.     Rest  of  body  and  mind,  or  at  least 
abstention  from  active  exercise,  is  necessary  for  a  few  moments 
before  meals  and  for  about  an  hour  afterward.   Depressing  thoughts 
and  business  preoccupations  should  be  banished  from  the  table. 

Concerning  the  interaction  of  food  and  work,  nothing  is  more 
illuminating  than  the  following  remarks  of  Chittenden: 

"  It  is  a  mistake  to  assume  the  necessity  for  a  hearty  rneal  because 
heavy  work  is  about  to  be  done.  It  is  certainly  far  more  rational 
from  a  physiological  standpoint  to  leave  the  hearty  meal  until  the 
day's  work  is  accomplished. 

"  We  seemingly  forget  that  the  energy  of  muscular  contraction 
comes  not  from  the  foodstuffs  present  at  the  time  in  the  stomach  and 
intestinal  tract,  but  rather  from  the  absorbed  material  stored  up  in  the 
muscles  and  which  was  digested  and  absorbed  a  day  or  two  before. 
Further,  it  is  to  be  remembered  that  the  very  process  of  digestion 
draws  to  the  gastro-intestinal  tract  a  large  supply  of  blood,  and  that 
a  large  amount  of  energy  is  needed  for  the  process  of  secretion,  di- 
gestion, absorption,  and  peristalsis,  which  are  of  necessity  incited 
by  the  presence  of  food  in  the  stomach  and  intestines,  thereby  actu- 
ally diminishing  the  amount  of  energy  available  at  the  place  where 
it  is  most  needed. 

"  Why,  then,  draw  upon  the  resources  of  the  body  just  at  a  time, 
or  slightly  prior  to  the  time,  when  the  work  we  desire  to  perform, 
either  muscular  or  mental,  calls  for  a  copious  blood  supply  in  muscle 
or  brain,  and  when  all  available  energy  is  needed  for  the  task  that 
is  to  be  accomplished. 

"  We  are  wont  to  compare  the  working  body  with  a  machine,  the 
boiler,  engine,  etc.,  overlooking  the  fact  that  the  animal  mechanism 
differs  from  the  machine  in  at  least  one  important  respect.  When  we 
desire  to  set  machinery  in  operation  we  must  get  up  steam,  and  so  a 
fire  is  started  under  the  boiler  and  steam  is  generated  in  proportion 
as  fuel  is  burned.  The  source  of  energy  made  use  of  in  moving  the 
machinery  is  the  extraneous  combustible  material  introduced  into 
the  fire-box,  but  the  energy  of  muscular  contraction,  for  example, 


4O8  MILITARY    HYGIENE. 

comes  not  from  the  oxidizable  food  material  in  the  stomach,  but 
from  the  material  of  the  muscle  itself.  In  other  words,  in  the 
animal  body  it  is  a  part  of  the  tissue  framework  that  is  burned  up, 
and  the  ability  to  endure  continued  muscular  strain  depends  upon 
the  nutritive  condition  of  the  muscle  involved,  and  not  upon  the 
amount  of  food  contained  in,  or  introduced  into  the  stomach." 


CHAPTER  XXXIV. 
BEVERAGES. 

Beverages  are  conveniently  divided  into  alcoholic  and  non- 
alcoholic. 

Of  the  non-alcoholic  beverages,  those  which  especially  concern  the 
soldier  are  coffee,  tea  and  chocolate. 

Coffee  is  the  name  of  the  seed  of  the  shrub  Coffea  arabica  culti- 
vated in  many  tropical  countries,  as  well  as  of  the  beverage  prepared 
from  it.  Except  in  the  hands  of  an  expert,  it  is  difficult  to  judge 
of  the  quality  of  the  seed,  or  berry,  from  its  size,  shape  or  color,  as 
these  vary  considerably  on  the  same  plant  and  are  otherwise  easily 
altered.  By  roasting  the  green  berries  until  they  acquire  an  even, 
dark  reddish-brown  color,  characteristic  aromatic  and  empyreumatic 
principles  are  developed ;  as  they  are  volatile,  coffee  should  be 
roasted  in  a  closed  vessel  and  only  a  short  time  before  being  used ; 
for  the  same  reason,  roasted  coffee  should  be  kept  in  tight  vessels 
and  only  ground  as  needed.  The  taste  is  often  much  improved  by 
the  addition  of  a  little  butter  and  sugar  before  roasting.  The  com- 
position of  roasted  coffee  is  about  2  per  cent,  of  water,  i  of  caffeine, 
12  of  fatty  matters,  12  of  nitrogenous  substances,  4  or  5  of  tannic 
acid,  very  little  sugar,  a  minute  proportion  of  volatile  oil  and  of 
aromatic  principle,  a  large  amount  of  cellulose  and  extractive  mat- 
ters and  nearly  5  of  mineral  salts.  The  principal  active  constituent 
is  the  alkaloid  caffeine,  of  which  a  cup  of  black  coffee  contains  about 
i  grain. 

The  berry  should  be  ground  into  coarse  powder ;  if  ground  too 
fine,  part  of  the  flavor  is  destroyed.  In  order  to  preserve  its  aro- 
matic principles  coffee  should  be  prepared  only  by  infusion.  The 
ground  coffee  is  put  in  boiling  water,  two  or  three  heaping  table- 
spoonfuls  to  the  quart,  and  then  the  pot  removed  far  enough  from 
the  fire  to  keep  it  just  below  the  boiling  point  for  10  to  15  minutes. 

Caffeine  produces  a  slight  increase  of  blood  pressure  and  slowing 
of  the  pulse.  It  is  our  best  cerebral  stimulant,  improving  all  the 
mental  functions,  causing  clearness  and  rapidity  of  thought,  alert- 
ness and  wakefulness.  It  is  also  a  typical  motor  stimulant,  causing 

409 


4IO  MILITARY    HYGIENE. 

a  decided  increase  in  speed,  as  well  as  in  the  accuracy  and  coordina- 
tion of  movements.  It  enables  the  muscles  to  contract  more  vigor- 
ously, and  without  secondary  depression,  so  that  the  sum  total  of 
muscular  work  is  increased  (H.  C.  Wood,  Jr.)  The  real  stimula- 
tion of  caffeine  does  not  begin  until  about  an  hour  after  ingestion 
and,  so  long  as  it  is  used  in  moderation,  this  stimulation  is  not  fol- 
lowed by  subsequent  depression.  Caffeine  is  also  an  active  diuretic. 
When  taken  too  freely,  as  coffee  or  tea,  it  is  liable  to  cause  general 
nervousness,  irritability,  insomnia,  functional  irregularity  of  the 
heart  and  derangement  of  all  the  digestive  functions. 

Coffee  acts  as  a  gentle  laxative,  whereas  tea,  owing  to  its  astrin- 
gent constituents,  may  have  the  opposite  effect.  It  is  not  usually 
so  well  borne  as  tea  by  dyspeptics. 

Tea  consists  of  the  leaves  of  the  shrub  Thea  chinensis  cultivated 
in  many  tropical  and  semi-tropical  countries,  and  is  likewise  the 
name  of  the  beverage  prepared  from  them.  Tea  of  excellent  quality 
is  grown  in  our  Southern  States.  Green  tea  and  black  tea  differ 
only  in  the  method  of  preparation ;  the  former  being  immediately 
dried  after  picking,  and  the  latter  previously  allowed  to  undergo  a 
slight  degree  of  fermentation.  Black  tea  is  generally  higher  in 
caffeine  and  much  lower  in  tannin  than  green  tea.  According  to 
Konig,  average  tea  contains  21.22  of  nitrogenous  matters,  1.35  of 
theine,  0.67  of  volatile  oil,  10.75  °f  fat>  resin,  gum,  etc.,  7.76  of  tan- 
nic  acid,  37  of  other  extractives,  cellulose,  etc.,  and  5.11  of  mineral 
matters.  Its  active  principle,  theine,  is  identical  with  caffeine,  and 
quite  variable  in  quantity,  sometimes  amounting  to  3  per  cent,  in 
black  teas. 

Tea,  as  beverage,  should  be  made,  like  coffee,  by  infusion.  Boil- 
ing dissipates  the  aroma  and  dissolves  much  of  the  astringent  and 
bitter  principles.  As  the  quality  of  tea  depends  largely  upon  the 
mode  of  its  preparation,  the  following  rules  should  be  observed : 
Take  fresh  water,  not  water  that  has  become  flat  by  standing  on  the 
stove  or  in  the  waterback ;  bring  it  quickly  to  a  hard  boil ;  fill  the 
teapot  and  set  it  on  the  fire  for  one  minute  in  order  that  it  may  get 
thoroughly  heated ;  pour  off  the  water  and  put  into  the  pot  one 
teaspoonful  of  the  leaves  for  every  teacupful  of  tea  that  is  to  be 
drawn,  and  one  for  the  pot ;  then  pour  on  the  boiling  water  and  set 
the  covered  pot  on  the  stove  or  near  the  fire  to  "  draw,"  but  not  to 
boil.  It  should  draw  just  enough  to  liberate  the  essential  oil  which 


BEVERAGES. 


411 


constitutes  its  aroma,  but  not  long  enough  to  drive  it  off  or  to  dis- 
solve the  tannin  which  gives  the  tea  a  disagreeable  taste.  The  time 
varies  with  the  different  teas,  from  five  to  ten  minutes.  (Manual 
for  Army  Cooks.)  The  most  delicate  portion  of  the  infusion  is  that 
poured  off  within  three  or  four  minutes. 


FIG.  86. —  Coffee  roasted  and  ground,  free  from  all  adulteration.     (Hassall.) 

Should  the  soldier  use  coffee  or  tea  in  the  field  ?  Both  are  gentle 
stimulants  which  cheer  and  refresh,  relieving  fatigue  and  the  sensa- 
tion of  hunger.  The  addition  of  sugar  and  cream  gives  them  de- 
cided nutritive  value  and  increases  their  power  to  evolve  muscular 
energy.  Coffee,  among  male  adults,  is  more  generally  used  than 
tea  in  this  country,  as  well  as  in  France  and  Germany,  while  tea  is 
preferred  in  England,  Russia,  Japan  and  China.  This  appears  to 
be  in  a  large  measure  a  matter  of  habit  and  custom.  There  is  good 
evidence  that,  to  relieve  thirst  on  a  hot  or  cold  day,  as  well  as  to 
appease  hunger  and  sustain  energy,  nothing  is  quite  so  satisfying  as 
a  glass  of  tea ;  the  extended  experience  of  English  officers  on  the 
torrid  plains  of  India,  as  well  as  that  of  Russians  in  Siberia  and 
Manchuria,  appears  to  be  conclusive  on  that  point.  The  opinion  of 
the  English  in  India  is  doubtless  correctly  expressed  in  the  following 
declaration  of  Sir  Havelock  Charles :  "  Tea  is  the  drink  par  excel- 


412  MILITARY    HYGIENE. 

lence  from  the  snows  of  the  Pamirs  to  the  scorching  sands  of 
Rajputana ;  I  have  tried  it  and  seen  its  effects."  It  seems  also  that 
more  caffeine  can  be  taken  with  impunity  in  the  form  of  tea  than  as 
coffee. 

For  the  soldier  in  the  field  tea  possesses  some  obvious  advantages. 
For  equal  weight  it  yields  one  and  a  half  or  frequently  twice  as  much 
caffeine  as  coffee,  so  that  less  is  needed  to  make  the  same  quantity 
of  infusion.  It  is  much  easier  to  transport,  preserve  and  prepare. 
The  weight  and  bulk  of  enough  tea,  in  compressed  tablets,  to  last  a 
soldier  a  week  is  a  negligible  quantity  in  his  haversack.  Not  only  is 
coffee  heavier  and  more  bulky,  but  its  proper  roasting  and  grinding 
in  the  field  is  often  a  difficult  process,  or,  if  issued  roasted  and 
ground,  great  care  is  required  to  prevent  deterioration.'  The  most 
practical  way  to  use  coffee  in  the  field  is  in  the  form  of  compressed 
cakes  with  impervious  wrappers,  as  in  the  French  service,  or  of  a 
strong  and  stable  liquid  extract  requiring  nothing  but  the  addition 
of  hot  water,  such  as  is  sometimes  used  in  the  Russian  service.  Tea 
and  coffee  being  prepared  with  water  that  has  been  boiled  are  ster- 
ilized beverages  and  of  great  value  wherever  water  is  contaminated ; 
but  tea,  being  more  aromatic  than  coffee,  can  be  diluted  to  a  much 
greater  extent  without  ceasing  to  be  palatable,  therefore  can  be  used 
practically  ad  libitum  and  more  readily  take  the  place  of  water  as  a 
safe  drink.  In  the  absence  of  fire,  good  tea  can  also  be  prepared 
with  cold  water  if  time  permits.  The  tannin  in  tea  is  objectionable 
on  account  of  its  astringent  and  constipating  effect,  but  a  properly 
prepared  infusion,  especially  when  diluted,  never  contains  enough 
of  it  to  be  harmful.  On  the  other  hand,  tannin  in  tea  is  not  without 
redeeming  features ;  it  may  render  good  service  in  diarrhea  and,  as 
an  antiseptic,  may  help  to  purify  water  that  cannot  be  boiled. 

Cocoa  is  derived  from  the  seeds  of  Theobroma  cacao,  a  tree  of 
tropical  America,  in  no  way  related  to  the  cocoanut  palm.  The  fruit 
is  a  rigid,  pointed  pod,  six  to  ten  inches  long,  containing  from  25 
to  40  seeds  or  "  beans."  These  undergo  a  process  of  fermentation, 
then  are  dried  in  the  sun,  roasted  and  freed  from  the  germs.  Mixed 
with  about  an  equal  quantity  of  sugar  and  spiced  with  vanilla  beans 
and  cinnamon,  they  constitute  the  ordinary  sweet  chocolate.  Cocoa 
contains  13  per  cent,  of  proteins,  49  of  fat  (cocoa  butter),  13  of 
starch  and  2  or  3  of  potassium  phosphate.  It  contains  also  an  aver- 
age of  1.50  per  cent,  of  the  alkaloid  theobromine,  closely  related  to 


BEVERAGES.  413 

caffeine,  but  somewhat  less  stimulant.  The  principal  constituents 
of  good  chocolate  are  57  per  cent,  of  sugar,  22  of  cocoa  butter,  1.33 
of  theobromine,  4.75  of  proteins  and  1.48  of  tartaric  acid. 

Cocoa,  therefore,  especially  as  chocolate,  is  not  only  a  mild  stimu- 
lant, but,  unlike  tea  and  coffee,  a  valuable  food  in  condensed  form, 
capable  of  evolving  much  muscular  energy  in  time  of  need.  Choco- 
late is  an  important  component  of  the  emergency  ration  and  an 
excellent  article  for  the  soldier  to  carry  in  his  haversack  whenever 
rations  are  scant  and  the  work  arduous. 

Kola  nut,  the  fruit  of  an  African  tree,  contains  about  2  per  cent, 
of  caffeine,  some  theobromine,  starch,  sugar  and  a  volatile  oil.  It  is 
used  by  mastication  or  in  the  form  of  various  fluid  preparations. 
It  is  a  stimulant  of  the  heart  and  respiration,  temporarily  increasing 
muscular  energy  and  mental  power,  and  has  been  recommended  to 
relieve  the  fatigue  of  long  marches  on  scant  rations.  It  is  generally 
believed,  however,  that  its  active  effects  are  only  those  of  caffeine 
and  can  be  more  conveniently  produced  by  the  use  of  coffee  or  tea. 

Other  noteworthy  plants  containing  caffeine  are: 

Mate  (pronounced  matay),  species  of  Ilex  which,  in  Paraguay  and 
other  South  American  countries,  takes  the  place  of  Chinese  tea, 
containing  about  the  same  proportion  of  alkaloid. 

Guarana,  a  preparation  from  the  seeds  of  a  climbing  shrub  of 
Brazil,  containing  4  or  5  per  cent,  of  caffeine. 

The  so-called  "  soft  drinks,"  consumed  in  such  vast  quantities  dur- 
ing the  summer,  are  seldom  above  suspicion,  and  should  be  used 
with  discretion.  They  are  often  prepared  with  contaminated  water, 
or  water  taken  from  the  nearest  and  most  convenient  supply.  They 
nearly  all  contain  saccharin,  which  has  been  shown  to  be  injurious 
when  habitually  consumed.  The  extract  of  soap-bark,  to  produce 
foaming,  is  also  largely  used  in  their  preparation ;  this  bark  con- 
tains saponin,  a  toxic  principle.  Besides  chemical  flavorings  and 
coloring  substances  usually  added,  caffeine  is  also  a  common  ingre- 
dient, particularly  dangerous  for  children  and  young  people  who 
indulge  so  freely  in  those  drinks. 

Concerning  water  drinking,  see  under  March,  p.  239,  and  also 
p.  694. 


414  MILITARY    HYGIENE. 

ALCOHOLIC   BEVERAGES. 

These  beverages  include :  i ,  fermented  drinks,  either  made  from 
malt,  such  as  beer,  ale  and  porter,  or  from  saccharine  liquids  and 
fruit  juices,  such  as  wine  and  cider ;  2,  distilled  drinks,  the  product 
of  distillation  of  fermented  saccharine  solutions,  such  as  whiskey, 
brandy  and  rum. 

The  active  and  essential  principle  of  all  these  beverages  is  ethylic 
alcohol  in  variable  quantity. 

The  food  value  of  alcohol  and  its  effects  upon  the  economy  is  a 
subject  beset  with  difficulties,  one  studied  by  many  physiologists, 
but  often  with  contradictory  results.  The  following  conclusions  are 
those  now  generally  accepted.  Atwater  and  others  have  demon- 
strated that  if  alcohol,  in  small  quantity  and  for  a  few  days,  is  made 
to  take  the  place  of  its  isodynamic  equivalent  of  fat  in  the  diet,  the 
number  of  calories  evolved  remains  the  same ;  therefore,  that  within 
certain  limits,  alcohol  is  oxidized  and  a  real  food.  In  small  quan- 
tity it  may  also  act  as  a  stimulant,  that  is,  increase  the  blood  pressure 
and  the  systolic  output  of  the  blood.  This  rise  in  the  blood  pressure, 
however,  is  transitory,  seldom  lasting  more  than  a  few  minutes.  It 
has  been  found  that,  even  in  very  moderate  doses,  alcohol  increases 
the  discharge  of  uric  acid  in  man,  a  fact  leading  to  the  suspicion 
that,  even  then,  it  has  a  deteriorating  effect.  Cheveau  has  shown 
that  when  alcohol  is  substituted  for  some  time  to  the  fats,  the 
muscular  energy  falls  and  the  body  weight  decreases.  The  sensation 
of  warmth  experienced  after  the  ingestion  of  an  alcoholic  drink  is 
due  to  the  dilatation  of  the  peripheral  and  pulmonary  capillaries ; 
but  this  is  soon  followed  by  a  more  active  radiation  of  heat  and  in- 
creased evaporation,  so  that  the  loss  exceeds  the  gain ;  thus  after 
an  ordinary  intoxication  the  body  temperature  may  fall  2°  or  3°F. 
below  normal.  There  is  a  general  agreement  that  in  large  doses, 
namely,  in  excess  of  10  to  15  c.  c.,  alcohol  acts  as  a  depressant  and 
is  harmful.  The  line  separating  the  stimulating  from  the  depress- 
ing dose  varies  according  to  individuals,  and  in  the  same  individuals 
at  different  times.  We  may  then  conclude  that,  except  in  small 
doses,  or  when  the  body  actually  lacks  food,  the  temporary  increase 
of  pulse,  respiration  and  muscular  energy  produced  by  alcohol  is 
succeeded  by  a  stage  of  depression  and  mental  dullness  which  more 
than  offsets  the  good  effects  of  the  stage  of  stimulation. 

As  a  medicine,  alcohol,  under  many  forms,  has  doubtless  a  useful 


BEVERAGES.  415 

part  to  play,  and  is  often  advantageously  administered  in  cases  of 
exhaustion  or  heart  failure,  but  even  in  such  cases  other  stimulants 
may  be  preferable.  It  should  always  be  given  in  small  quantities 
and  its  effects  watched,  for  the  toxic  dose  is  soon  reached  and  the 
second  state  of  the  patient  may  be  worse  than  the  first. 

In  health,  physiologists  agree  that  alcoholic  beverages  are  unneces- 
sary, and  the  statistics  of  insurance  companies  tend  to  show  that 
total  abstainers  may  expect  a  greater  longevity  than  even  those  who 
indulge  in  moderation.  The  use  of  whiskey,  wine  or  beer,  formerly 
pretty  general  in  armies  and  navies,  as  part  of  the  ration,  is  now 
restricted  to  exceptional  occasions  of  fatigue  and  exposure  and,  in 
some  countries,  as  in  ours,  completely  suppresseed.  There  are  doubt- 
less circumstances  in  very  cold  and  very  hot  regions  wher  a  little 
wine  or  small  amount  of  diluted  whiskey  may  be  beneficial,  but  the 
difficulty  of  correct  dosage  and  the  danger  of  over-indulgence  are  so 
great  that  it  is  safer,  if  we  wish  to  obtain  the  best  results  from  our 
nervous  and  muscular  energy,  as  well  as  from  our  mental  powers, 
to  trust  to  coffee,  tea  and  chocolate. 

Concerning  the  use  of  alcoholic  beverages,  several  points  must  be 
borne  in  mind.  The  most  important  is  that  the  active  toxic  principle 
is  alcohol  and  not  any  of  the  impurities  which  may  be  associated 
with  it ;  the  proportion  of  these,  as  a  very  general  rule,  is  much  too 
small  to  produce  any  decided  effect.  The  various  manifestations  of 
alcoholism,  therefore,  are  due  to  the  quantity,  not  to  the  quality  of 
the  alcohol.  The  exception  to  this  rule  is  in  the  case  of  absinthe, 
vermouth  and  various  bitters,  in  which  poisonous  essential  oils  are 
used,  or  again  in  the  case  of  the  crudely  distilled  spirits  found  in 
certain  countries,  like  the  "  mescal "  of  Mexico  and  the  "  vino  "  of 
the  Philippines.  Another  point  is  that  the  more  diluted  the  bever- 
age, the  less  likely  is  the  passage  into  the  blood  of  enough  alcohol 
at  any  time  to  produce  toxic  symptoms,  and  the  less  harmful  the 
result.  Thus  France  is  said  to  consume  more  alcohol  than  any  other 
nation  (Arnould},  but  as  much  of  it  is  in  the  form  of  wine,  alcohol- 
ism does  not  appear  to  be  worse  there  than  in  several  other  coun- 
tries. Spain  and  Italy  consume  large  quantities  of  alcohol,  but  also 
mostly  as  wine,  and  they  are  among  the  countries  which  suffer  least 
from  alcoholism.  All  observations  tend  to  show  that,  for  those  who 
desire  or  need  an  alcoholic  beverage,  the  most  acceptable,  that  pro- 
vided by  nature  from  the  beginning,  is  light,  unadulterated  wine. 


4l6  MILITARY    HYGIENE. 

It  seems  probable  that  a  very  moderate  use  of  it,  at  meals,  can  be 
indulged  in  with  comparative  impunity. 

The  proportion  of  alcohol  in  the  many  drinks  consumed  varies 
greatly.  Any  beverage  containing  less  than  2  per  cent,  may  be  con- 
sidered as  non-intoxicant.  Beers  average  from  3.5  to  5  per  cent. ; 
wines  from  6  to  15;  spirits  (whiskey,  brandy,  rum,  etc.),  from  40 
to  45.  Of  the  latter,  pure  native  whiskey,  a  few  years  old,  when 
much  of  the  fusel  oil  has  disappeared  and  been  replaced  by  aromatic 
principles,  is  the  least  objectionable.  The  maximum  amount  of 
alcohol  which  anybody  can  take  in  health,  without  immediate  appar- 
ent harm,  is  variable ;  it  should  never  be  more  than  enough  to  pro- 
duce a  mild  degree  of  temporary  stimulation,  with  no  depressing 
after-effect.  This  amount  for  the  day  should  not  exceed,  as  a 
general  average,  one  ounce  of  alcohol,  or  two  ounces  of  whiskey, 
or  ten  of  light  wine,  or  sixteen  of  beer.  Every  prudent  man  should 
know  what  is,  for  him,  a  safe  maximum  dose  and  never  go  beyond  it, 
keeping  full  mastery  over  this,  as  well  as  other  dangerous  appetites. 
For  many  people  of  nervous,  ill-controlled  temperament,  the  only 
safe  rule  is  complete  abstention. 

There  is  a  consensus  of  opinion  among  experienced  field  officers, 
especially  among  medical  officers,  that  soldiers  on  active  duty  do 
not  need  alcoholic  drinks  and  are  capable  of  much  better  and  more 
continued  achievements  without  them.  Therefore  during  the  pres- 
ent European  War  it  has  been  the  endeavor  of  all  the  belligerent 
governments  to  reduce  the  consumption  of  alcohol  in  the  field  to 
as  low  a  minimum  as  circumstances  permit,  too  often  a  minimum 
which  could  be  still  further  reduced  with  great  benefit  were  it  not 
for  the  antagonism  of  uneducated  public  opinion. 

Alcoholism. —  Only  a  few  remarks  on  alcoholism  are  necessary. 
(See  p.  131.)  The  toxicity  of  alcohol  in  the  blood  is  mainly  due  to 
its  dehydrating  effect  upon  cell  protoplasm  and  inhibiting  action  upon 
all  forms  of  cell  activities,  with  consequent  degeneration  of  the 
tissues.  The  chief  effects  and  symptoms  of  alcoholism  are :  con- 
gestion of  the  stomach  with  increase  of  connective  tissue,  degenera- 
tion and  atrophy  of  the  secreting  glands  and  consequent  impaired 
digestion ;  congestion  and  degeneration  of  the  liver,  the  contracting 
connective  tissue  causing  atrophy  of  the  portal  canals  and  hepatic 
cells,  a  condition  known  as  cirrhosis  and  generally  accompanied  by 
abdominal  dropsy ;  degeneration  of  the  brain  substance  with  motor 


BEVERAGES.  417 

and  sensory  disturbances,  accompanied  by  gradual  dulling  and  fail- 
ing of  the  mental  and  moral  faculties ;  fatty  degeneration  of  the 
heart  and  atheromatous  or  sclerotic  condition  of  the  arteries,  leading 
to  apoplexy ;  decrease  of  muscular  energy  and  capacity  for  work ; 
failing  of  the  power  of  resistance  to  all  diseases,  the  facility  with 
which  free  drinkers  succumb  to  pneumonia  or  contract  tuberculosis 
being  notorious.  It  has  also  been  observed  that  even  moderate 
drinkers  contract  disease  (outside  of  alcoholism)  more  frequently 
than  total  abstainers. 

From  the  examination  of  the  bodies  of  460  alcoholics,  Hultgen 
(/.  Am.  Med.  Ass.,  1910)  found  morbid  alterations  in  the  central 
and  peripheral  nervous  system  in  93  per  cent.,  thus  proving  that 
alcohol  is  essentially  a  narcotic.  The  effects  on  the  gastro-intestinal 
system  were  likewise  marked  and  striking,  pharyngitis,  gastritis  and 
hepatic  disorders  existing  in  83  per  cent.  Arterio-sclerosis  and 
valvular  lesions  were  not  common,  indicating  that  the  sclerogenic 
action  of  alcohol  is  perhaps  not  as  great  as  had  been  believed.  It 
was  surprising  to  find  that  those  tissues  through  which  alcohol  is 
eliminated,  namely,  lungs  and  kidneys,  were  least  affected.  As  re- 
gards the  lungs,  however,  these  observations  do  not  accord  with 
those  of  other  observers.  Thus  Jacques  Bertillon,  after  a  thorough 
investigation  of  the  subject,  sums  up  in  the  statement  that  "  of  all 
causes  which  favor  the  development  of  tuberculosis,  in  France, 
there  is  none  that  has  the  importance  of  alcohol."  Kis  statistics 
show  that  alcohol,  as  brandy  or  whiskey,  is  much  more  deleterious 
than  in  the  form  of  wine,  the  ratio  of  tuberculosis,  in  France,  in- 
creasing proportionally  with  that  of  the  per  capita  consumption  of 
spirits.  This  divergence  of  views,  however,  is  easily  reconciled  by 
the  consideration  of  the  fact  that  alcoholics  who  develop  tubercu- 
losis, lose,  to  a  large  extent,  their  appetite  for  alcohol  in  the 
advanced  stage  of  that  disease,  so  that  the  true  cause  of  their  death 
is  overlooked  and  recorded  simply  as  tuberculosis. 

METHYLIC  ALCOHOL,  (wood  alcohol),  although  a  well-known  rank 
poison,  is  commonly  used  as  an  adulterant  of,  and  substitute  for, 
ethylic  alcohol  in  cheap  whiskey  and  other  alcoholic  beverages ;  it 
is  also  extensively  employed  in  the  arts,  as  well  as  in  many  patent 
medicines  and  toilet  preparations.  The  symptoms  of  acute  poison- 
ing are  severe  gastro-intestinal  disturbances,  accompanied  by  abdom- 
inal pain,  weakness,  nausea,  vomiting,  vertigo,  headache,  dilated 


418  MILITARY    HYGIENE. 

pupils  and  blindness.  In  fatal  cases  there  is  marked  cardiac  depres- 
sion, sighing  respiration,  cold  sweats,  delirium,  convulsions  and 
coma.  The  silly,  irresponsible  excitement  of  ordinary  drunkenness 
is  not  seen,  and  even  staggering  may  be  absent.  Wood  alcohol  is 
much  more  slowly  absorbed  and  eliminated  than  ethyl  alcohol,  so  that 
even  small  doses  may  have  a  cumulative  effect  and  do  serious  dam- 
age. Sometimes,  after  taking  a  large  dose,  one  or  two  days  may 
elapse  before  symptoms  of  poisoning  manifest  themselves. 

It  is  estimated  that  if  10  persons  drink,  each,  4  ounces  of  wood 
alcohol  ("Columbian  spirits")  within  three  hours,  all  will  have 
marked  abdominal  distress ;  four  will  die,  two  will  be  permanently 
blind  and  four  will  recover.* 

The  treatment  consists  in  getting  rid  of  the  poison  from  the  stom- 
ach and  intestines  by  means  of  the  stomach  pump  and  rectal  injec- 
tions ;  and  the  use  of  stimulants,  especially  strychnine  and  coffee. 

The  manufacture  and  sale  of  wood  alcohol  are  an  obvious  menace 
to  public  health  and  call  urgently  for  strict  Government  intervention. 


*  Death  and  blindness  from  wood  alcohol.     C.  A.  Wood.     /.  A.  M.  A., 
Nov.  30,  1912. 


CHAPTER  XXXV. 
CLOTHING  AND  UNIFORM. 

The  fabrics  used  to  clothe  the  body  are  made  from  animal  and 
vegetable  fibers,  especially  from  those  of  wool,  silk,  cotton  and  linen. 
These  fibers  are  easily  distinguished  under  the  microscope.  (Fig. 
87.)  The  wool  fiber  is  cylindrical  and  covered  with  imbricated 
scales ;  these  are  sharp  and  numerous  in  the  best  material,  but  worn 
out  in  shoddy;  they  are  the  cause  of  the  matting  together  and 
shrinkage  of  wet  woolen  fabrics  under  pressure.  The  cotton  fiber 
is  flat  and  twisted,  with  thickened  borders.  The  silk  fiber  is  a 
structureless  tube  without  any  marking.  The  linen  fiber  is  a  cylinder 
with  cross  lines  indicating  the  division  of  the  cells,  and  occasional 
filaments  at  the  lines. 

The  chemical  analysis  of  textile  fabrics  is  difficult  and  unreliable ; 
an  estimate  of  their  relative  proportion  may  be  formed  by  placing 
them  in  a  10  per  cent,  solution  of  potash  or  soda;  the  fibers  of  wool 
and  silk  will  be  dissolved  while  those  of  cotton  and  linen  remain 
intact  (Rubner). 

The  specific  weight  of  the  various  materials  used  for  clothing 
depends  chiefly  upon  their  structure,  that  is  to  say,  the  mode  of 
weaving  or  knitting,  their  compactness  and  the  quantity  of  air  in- 
closed in  their  meshes ;  thus  linen  goods  having  all  the  fibers  in 
close  parallel  planes,  and  smooth  surfaces,  are  the  heaviest ;  woolen 
flannels,  with  fibers  loosely  interlaced  in  several  directions,  are  the 
lightest,  while  knit  goods  are  intermediate.  As  will  soon  be  appar- 
ent, the  qualities  and  defects  of  textile  fabrics  are  all  closely  related 
to  their  specific  gravity.  The  following  table,  from  Arnould,*  is 
instructive : 


*Nouveaux  elements  d'Hygiene  de  Jules  Arnould.     5th  edition,  revised  by 
E.  Arnould. 


419 


420 


MILITARY    HYGIENE. 


Articles 

Specific  weight 

Volume  of  interstices 
per  cent. 

^^oolen  flannel             

O   IOI 

02    ^ 

Cotton  flannel    

o.  146 

88  8 

Knit  wool  

o.  170 

86  3 

Knit  cotton   

o.  199 

84.7 

Knit  silk       ...               

o  219 

8l   2 

Knit  linen    

0.148 

7*2       -3 

Cotton  cloth  

0.624 

^2.O 

Linen  cloth  

0.665 

48.0 

Furs  weigh  only  about  half  as  much  as  flannels,  containing  95  or 
96  per  cent,  of  air. 

The  general  properties  of  textile  fabrics  which  concern  the 
hygienist  are :  permeability  to  air,  hygroscopicity,  heat  radiation, 
heat  conductivity  and  heat  absorption. 

Permeability.  • —  Clothing  should  be  permeable  to  air  and  allow  a 
free  interchange  of  gases  in  its  meshes,  that  is  to  say,  sufficiently 
porous  to  permit  the  external  air  to  penetrate  to  the  surface  of  the 
body  and  allow  the  free  escape  of  the  carbon  dioxid  (CO2)  and 
sweat  (as  aqueous  vapor)  constantly  excreted  by  the  skin.  The 


FIG.  87.  —  Textile  fibers :  a  and  b,  wool  fibers ;  c,  silk  fiber ;  d,  linen  fiber  ; 
e,  cotton  fiber.     (Arnould.) 


CLOTHING    AND   UNIFORM.  421 

lighter  and  more  porous  the  fabric  the  greater  its  permeability,  but, 
with  the  same  fabric,  permeability  is  inversely  proportional  to  its 
thickness.  Woolen  flannel  is  the  most  permeable  textile  material, 
and  linen  cloth  the  least. 

Hygroscopicity.  —  Fabrics  hold  moisture  in  two  ways :  in  the  sub- 
stance of  the  fiber  itself  (hygroscopic  moisture)  and  in  the  interstices 
or  meshes  between  the  fibers  (interposition  moisture)  ;  pressure  and 
wringing  can  remove  the  latter  but  not  the  former.  Woolen  fabrics 
absorb  the  most  hygroscopic  moisture ;  then,  in  order,  those  of  silk, 
cotton  and  linen ;  this  moisture  swells  the  fiber  to  some  extent  but 
does  not  materially  impair  the  permeability  of  the  tissue  to  air. 
The  capacity  of  fabrics  for  interposition  moisture  depends  chiefly 
upon  their  texture ;  thus  the  maximum  capacity  of  woolen  flannel 
to  fill  up  its  interstices  by  sweat  or  rain  is  only  13  per  cent.,  while 
that  of  cotton  cloth  is  100;  in  other  words,  those  fabrics  capable 
of  holding  the  largest  quantity  of  hygroscopic  water  are  those 
that  retain  interposition  water  in  the  smallest  ratio  and  in  which, 
therefore,  permeability  is  least  diminished  by  wetting.  Flannel  and 
knit  goods  absorb  moisture,  and  lose  it,  much  more  slowly  than 
cotton  and  linen  cloth.  When,  after  exercise,  a  woolen  garment 
is  put  on,  the  vapor  from  the  body  is  condensed  and  absorbed  in 
the  fibers;  in  this  process  of  transformation  from  gas  to  liquid,  it 
gives  off  its  latent  heat,  producing  a  comfortable  feeling  of  warmth. 
At  the  same  time  the  evaporation  proceeds  slowly  and  without  any 
sensation  of  cold. 

Heat  Absorption.  —  The  heat  absorbing  power  of  garments,  in  the 
sunlight,  depends  entirely  upon  their  color  and  not  on  material 
or  texture;  white  absorbs  least;  then,  in  increasing  order,  khaki, 
olive-drab,  green,  red,  brown,  blue  and  black,  the  last-named  color 
absorbing  more  than  twice  as  much  as  white. 

For  this  reason  black  outer  garments  are  best  for  outdoor  use 
in  cold  weather  (in  order  to  absorb  more  solar  heat),  and  white 
garments  in  hot  weather.  Color  has  the  same  effect  upon  artificial 
heat ;  thus  water  in  a  black  kettle  on  the  stove  will  boil  more  quickly 
than  in  a  light-colored  one. 

The  heat-absorbing  power  of  garments  is  noteworthy  and,  in 
warm  countries,  deserves  special  attention,  as  shown  by  the  experi- 
ments of  the  "  Board  for  the  Study  of  Tropical  Diseases "  in 
Manila,  especially  in  reference  to  khaki  and  olive-drab  cotton  cloth. 


422  MILITARY    HYGIENE. 

A  thermometer  placed  beneath  olive-drab  material  exposed  to  the 
direct  rays  of  the  sun,  rose  from  93°  (air  temperature  in  sun)  to 
126°  F.  in  about  an  hour,  the  air  temperature  meanwhile  remaining 
unchanged,  whereas  beneath  white  drilling  the  temperature  usually 
remained  below  that  of  the  body.  The  average  temperatures  of 
several  observations,  in  sunlight,  were  108.3°  beneath  olive-drab, 
105.6°  beneath  khaki,  and  95.4°  beneath  white.  These  observations 
were  made  at  a  time  when  the  intensity  of  sunlight  was  not  at  its 
maximum,  so  that  the  difference  between  the  three  materials  would 
have  been  still  more  marked  at  other  seasons.  Between  helmets 
covered  respectively  with  khaki  and  olive-drab  material,  and  ex- 
posed to  a  bright  sunlight,  the  difference  between  the  thermometers 
placed  beneath  them  was  8.28°  F.  in  favor  of  khaki. 

It  should  be  stated  that  the  difference  in  the  temperatures  beneath 
khaki  and  olive-drab  worn  on  the  human  body  is  not  as  great  as 
when  these  materials  are  placed  on  a  table  as  in  the  above  experi- 
ments ;  this  is  owing  to  the  power  of  warm-blooded  animals  to 
prevent  the  body  temperature  from  rising,  by  perspiration ;  there- 
fore the  warmer  the  garment,  on  a  warm  day,  the  more  active  the 
perspiration  and  the  greater  the  strain  upon  the  heat-regulating 
mechanism. 

Heat  Radiation.  —  According  to  Rubner,  the  body  at  rest  expends, 
in  a  day,  about  2,700  calories ;  of  these,  95  per  cent,  are  lost  through 
the  skin,  namely  1,181  by  radiation,  833  by  conduction  and  558  by 
evaporation.  (See  page  364.) 

Heat  radiation,  such  as  takes  place  indoor  or  in  the  shade,  is, 
like  absorption,  affected  by  color,  black  radiating-  most  and  white 
least.  For  this  reason,  indoor  outer  garments  should  be  dark- 
colored  in  hot  weather  and  light-colored  in  cold  weather.  The  water 
which  boils  more  rapidly  in  a  black  kettle,  also  cools  off  more 
quickly  when  removed  from  the  stove.  As  regards  military  uniforms, 
radiation  is  of  little  importance  because  at  the  time  when  it  would 
be  of  value,  that  is,  in  barracks,  the  soldier  generally  discards  his 
outer  garment. 

Heat  Conductivity.  —  If  the  conductive  power  of  air  be  represented 
by  I,  that  of  wool  fiber  will  be  6,  of  silk  fiber  19,  and  of  cotton  and 
linen  fibers  30.  The  heat  conductivity  of  a  fabric  will  therefore 
depend  upon  the  nature  of  its  material  and  the  amount  of  air  it 
contains ;  flannels  and  knit  goods  having  the  least  conductive  fibers 


CLOTHING    AND   UNIFORM.  423 

and  the  most  porous  texture  will  conserve  the  body  heat  much 
better  than  cotton  and  linen  cloth. 

Permeability  to  air  reduces  heat  conductivity  but,  on  the  other 
hand,  favors  the  loss  of  heat  by  evaporation  and  convection;  there- 
fore it  must  be  properly  adjusted  to  atmospheric  conditions  by  vary- 
ing the  thickness  or  nature  of  the  clothing. 

The  conductive  power  of  water  being  28  times  as  great  as  that  of 
air,  that  of  any  tissue  is  necessarily  modified  by  the  amount  of 
moisture  it  contains,  especially  interposition  moisture;  wet  cotton 
and  linen  fabrics,  therefore,  lose  heat  much  more  rapidly  than  wet 
woolen  ones ;  they  cling  to  the  skin,  expelling  the  protective  layers 
of  air  between  the  several  garments,  and  by  their  rapid  evaporation 
chill  the  body. 

Evaporation.  —  The  evaporation  of  the  sweat  and  consequent 
cooling  of  the  surface  are  favored  by  permeable  porous  clothing. 
In  cold  weather,  when  the  sweat  is  reduced  to  a  minimum,  the  same 
degree  of  permeability  is  not  required  and  more  compact  clothing 
can  be  worn.  Evaporation  from  wet  garments  depends  chiefly 
upon  the  temperature  and  humidity  of  the  ambiant  air,  but  also 
increases  directly  wtih  the  proportion  of  water  they  contain,  being 
greater  from  linen  or  cotton  cloth  than  from  woolen  fabrics. 

Having  thus  briefly  summed  up  the  properties  and  effects  of 
textile  fabrics,  it  is  easy  to  determine  those  best  adapted  for  under- 
clothing and  for  outer  garments. 

UNDERCLOTHING. 

For  this  are  required  materials  of  low  conductivity  to  guard 
against  any  sudden  or  excessive  loss  of  body  heat,  permeable  to 
air  so  as  to  promote  the  excretion  and  evaporation  of  the  sweat, 
and  of  great  hygroscopic  power  so  that  the  sweat  be  readily 
absorbed  in  the  fibers  without  interfering  with  the  air  circulation. 
The  material  which  best  subserves  these  purposes  is  woolen  flannel, 
and  next  to  it  cotton  flannel.  Woolen  flannel,  in  contact  with  the 
skin,  will  readily  absorb  during  active  exercise  in  hot  weather,  50 
per  cent,  of  its  weight  of  perspiration ;  but  this  would  only  fill  10  to 
12  per  cent,  of  its  interstices,  while,  under  the  same  circumstances, 
a  cotton  or  linen  undershirt  would  have  68  per  cent,  of  its  air  spaces 
filled  up,  causing  nearly  complete  impermeability  to  air  and  forming 
a  serious  obstacle  to  the  evaporation  of  the  sweat,  with  resulting 


424  MILITARY    HYGIENE. 

heating  of  the  body,  increase  of  perspiration  and  more  complete 
saturation  of  the  undergarments.  It  is  also  to  be  remembered  that 
flannel  gives  off  its  moisture  by  evaporation  more  slowly  than  cotton 
and  linen,  and  cools  the  skin  correspondingly  less.  Lastly,  wool 
does  not  retain  the  organic  matter  and  salts  of  the  perspiration  and 
the  sebaceous  glands  to  the  same  extent  as  cotton  and  linen,  and 
therefore  is  less  soiled  in  the  same  space  of  time.  Flannel  is  not 
only  the  best  fabric  for  undergarments  in  winter  but  also  in  summer, 
by  varying  its  thickness.  The  undershirt  must  be  of  ample  size 
when  issued  and  reach  half  way  down  the  thigh.  In  cold  regions 
soldiers  should  be  allowed  to  draw  two  sizes  and,  in  winter,  to  wear 
one  over  the  other  when  necessary.  Fleece-lined  undershirts  and 
drawers  are  now  issued  for  service  in  Alaska. 

The  chief  objection  against  woolen  garments  is  their  irritation 
of  sensitive  skins,  and  their  shrinkage  and  hardening  when 
laundered.  Their  washing  requires  special  care :  it  should  be  done 
with  soap  containing  but  little  alkali  as  this  dissolves  the  natural 
oil  of  the  fiber  and  injures  its  texture;  the  garments  should  be 
immersed  and  shaken  in  lukewarm  or  cold  water,  rinsed  out  without 
being  beaten,  and  dried  after  only  very  moderate  wringing. 

Pure  wool,  however,  is  not  necessary  for  undergarments;  cotton 
or  other  material  may  be  advantageously  mixed  with  it  to  a  large 
extent  so  long  as  the  flannel  or  knit  structure  is  preserved. 

Silk  possesses  most  of  the  qualities  of  wool,  being  hygroscopic 
and  a  poor  heat  conductor  but,  in  warm  weather,  gets  too  easily 
sodden  with  perspiration  and,  in  that  state,  is  too  good  a  heat 
conductor  to  be  a  suitable  material  for  underclothing.  A  combina- 
tion of  wool  and  silk  is  the  ideal  material  for  the  purpose  in  hot 
countries,  the  so-called  "Anglo-Indian  gauze ;  "  it  is  more  lasting 
and  less  apt  to  shrink  than  cheaper  fabrics  of  cotton  and  wool. 

Cotton,  in  the  shape  of  flannel  or  knit  fabric,  although  inferior 
to  wool  for  underwear,  may  take  its  place  when  cost  is  to  be  con- 
sidered. Certain  cotton  fabrics,  such  as  "  twilled  lining,"  are  much 
used  in  India  for  underwear,  shirts  and  pajamas,  being  absorbent, 
easily  tolerated  by  delicate  skins  and  poor  conductors.  Linen  is 
not  suitable  for  the  purpose  unless  especially  woven  or  knit,  and 
then  only  for  warm  weather.  It  becomes  readily  saturated  with 
perspiration  and  requires  frequent  changes. 

Outer  Garments.  —  The  nature  and  thickness  of  outside  garments 


CLOTHING    AND   UNIFORM.  425 

will  depend  chiefly  upon  the  temperature  of  the  air.  In  cold 
weather,  dark  woolen  fabrics  will  be  best.  In  warm  weather,  cotton 
and  linen  garments  which  are  better  conductors  of  the  body  heat, 
and  therefore  cooler,  are  preferable;  in  color  they  should  be  white 
or  nearly  so  in  order  to  reflect  the  solar  heat  as  much  as  possible. 
Linen  goods  are  smooth  and  lustrous,  heavier  and  more  durable 
than  cotton  and  of  high  heat  conductivity ;  they  make  the  best  outer 
garments  for  warm  weather  and  tropical  countries.  For  outdoor 
use  in  the  tropics,  under  a  blazing  sun,  the  outer  garment  should 
not  only  be  white  but  of  sufficient  thickness  to  prevent  solar  pene- 
tration, for,  under  such  conditions,  solar  heat  may  readily  over- 
come nature's  method  of  maintaining  the  body  temperature  within 
physiological  limits ;  to  prevent  this  risk,  white  flannel  of  suitable 
thickness  is  indicated. 

SUITABLE   GARMENTS  AGAINST   THE  ACTINIC   BAYS. 

Of  late  years  much  attention,  has  been  paid  to  the  actinic  or 
chemical  effects  of  sunlight  upon  the  body,  especially  in  the  tropics 
(see  page  695).  They  are  chiefly  produced  by  the  ultra-violet,  or 
short  rays  of  the  spectrum,  and  least  active  in  the  red  and  orange. 
In  order  to  exclude  these  dangerous  actinic  rays,  it  has  been  pro- 
posed to  wear  red  or  orange  underwear  or  to  line  outer  garments 
and  head  covering  with  these  colors.  As  red  is  more  conspicuous 
and  a  less  durable  dye,  orange  is  more  commonly  used ;  orange  silk 
being  preferable  on  account  of  its  lightness  and  non-conductivity. 
To  avoid  complexity  of  garments,  Dr.  Sambon  has  devised  peculiar 
fabrics  ("solaro"  fabrics)  with  white  warp  or  outer  surface,  and 
black,  red  or  orange  weft  or  under  surface.  For  soldiers,  the  warp 
is  made  of  yellow  and  blue,  producing  a  khaki  or  drab  effect,  and 
the  weft  of  red. 

The  application  of  non-actinic  colors  to  the  soldier's  uniform 
presents  difficulties.  Orange  or  red  are  too  conspicuous  to  be  used 
as  lining  to  the  blouse,  or  for  undergarments  in  hot  countries  where 
the  soldier  is  strongly  inclined  to  discard  his  outer  clothing. 

It  has  been  found,  however,  that  opacity  of  garment  is  at  least 
as  effective  as  color,  and  that  a  black  fabric  (preferably  silk)  is 
altogether  best  for  the  purpose.  Therefore  a  black  undershirt 
suggests  itself.  For  the  soldier,  the  best  garment  would  be  a 
"  solaro  "  flannel  overshirt,  olive-drab  outside  and  black  inside.  It 


426  MILITARY    HYGIENE. 

is  especially  the  head  and  spine  that  should  be  protected  against 
the  injurious  actinic  sunlight  of  the  tropics;  hence  the  necessity  of 
a  black  lining  to  the  helmet  or  campaign  hat,  and  of  a  black  band, 
6  inches  wide,  along  the  middle  line  of  the  blouse  or  overshirt. 

Although  the  foregoing  remarks,  which  appear  in  the  first  edition 
of  this  work,  are  left  unchanged,  the  recent  experiments  with  colored 
underclothing,  described  elsewhere  (page  697),  have  shown  the  com- 
parative unimportance  of  the  effects  of  actinic  rays,  and  that  for 
the  great  majority  of  soldiers  these  effects  are  negligible. 

THE  UNIFORM. 

The  soldier's  uniform  must  combine  various  hygienic  and  military 
requirements.  The  proper  fabrics  having  been  selected,  it  should 
be  of  such  shape  and  size  as  to  be  suitable  and  comfortable,  and 
enable  the  wearer  to  perform  his  duties  to  the  best  advantage. 
Everything  must  be  sacrificed  to  these  primary  requirements.  It 
must  also  be  simple,  easily  put  on  and  removed,  and  consist  of  as 
few  garments  and  have  as  few  detachable  parts  as  possible.  All 
this  being  granted,  there  is  no  reason  why  it  should  not  also  be 
neat  and  possess  a  certain  degree  of  smartness  and  ornamentation, 
such  as  will  help  to  develop  in  the  soldier  a  spirit  of  pride  in  his 
calling;  it  is  possible  that,  in  our  service,  not  enough  importance 
has  been  given  to  the  esthetic  aspect  of  the  uniform. 

In  size,  the  uniform  should  fit  the  body,  but  not  too  snugly,  so 
that  the  free  movements  of  the  extremities,  and  those  of  the  chest 
in  breathing,  be  in  no  way  impeded;  it  is  especially  necessary  that 
the  neck  be  not  constricted  by  a  tight  collar.  The  layers  of  warm 
air  interposed  between  the  skin  and  the  clothing  should  be  allowed 
to  escape  freely  in  summer,  especially  at  the  neck;  but,  in  cold 
weather,  it  may  be  advisable  to  restrict  this  air  circulation  by 
tightening  the  garments  at  the  collar,  wrists  and  ankles.  It  is  im- 
portant that  the  trousers  and  breeches  extend  well  above  the  navel 
to  protect  the  abdomen,  and  be  tolerably  loose  about  the  seat  and 
crotch  to  prevent  friction  and  abrasion  in  marching  or  riding.  In 
our  service,  they  are  held  up  with  suspenders  or  a  webbing  waist- 
belt  ;  the  suspenders,  which  leave  the  waist  and  abdomen  free  from 
pressure,  are  always  preferable. 

The  color  of  the  uniform  in  garrison  is  regulated  simply  by 
esthetic  and  military  considerations.  In  the  field,  it  is  chiefly  regu- 


CLOTHING    AND   UNIFORM. 


437 


lated  by  the  necessity  of  being  as  invisible  as  possible  to  the  enemy. 
The  visibility  of  the  uniform  will  depend  more  or  less  upon  the 
background  against  which  it  is  projected,  but,  under  average  condi- 
tions, white  is  the  most  conspicuous  color  and  therefore  the  most 
objectionable;  then  come  the  following  colors  in  order  of  con- 
spicuousness ;  scarlet,  dark  blue,  yellow,  green,  butternut,  dust  or 
khaki,  olive-gray  drab.  At  dawn  and  sunset  of  a  cloudy  day,  as 
well  as  by  moonlight,  white  becomes  as  invisible  as  gray  and  brown, 
blue  and  scarlet  being  then  the  most  conspicuous  colors.  The  khaki 


FIG.  88. —  Dress  coat  for  all  enlisted  men. 


uniform  formerly  worn  by  our  men,  after  being  washed  became 
pale  yellowish-gray  and  comparatively  conspicuous ;  under  the  same 
conditions  the  olive-drab  uniform  is  nearly  completely  invisible. 
For  the  same  reason,  all  buttons  and  metal  ornaments,  as  well  as 
articles  of  equipment,  should  be  of  dull  material  not  liable  to  reflect 
sunlight. 

It  is  still  an  open  question,  however,  whether  invisibility  is  an 
unmixed  advantage,  especially  when  both  belligerents  wear  nearly 
the  same  kind  of  inconspicuous  uniform.  There  may  be  serious 
danger  of  failing  to  recognize  our  own  men  in  the  distance  and 
mistaking  them  for  the  enemy,  or  vice  versa,  allowing  the  enemy 
to  secure  important  positions  before  being  recognized. 


428 


MILITARY    HYGIENE. 


A  service  uniform  of  greenish-gray  color  has  been  adopted  by 
nearly  all  the  leading'  European  armies.  The  French  army  has  only 
recently  reached  some  definite  conclusion  in  regard  to  this;  mean- 
while, its  very  conspicuous  red  kepi  has  been  screened  under  a  dark- 
blue  cover. 

United  States  Army  Uniform.  —  In  all  arms  of  our  Army  the  en- 
listed man  is  provided  with  only  two  uniforms :  the  dress  and  the 
service  uniforms.  The  dress  coat  (Fig.  88)  is  a  single-breasted 
sack  coat  of  dark  blue  cloth,  fastened  with  six  regulation  buttons 
down  the  front,  with  standing  collar  and  shoulder  loops.  On 
occasions  of  ceremony,  cords  and  tassels  of  mohair  are  fastened 
across  the  front  of  it.  The  dress  trousers  are  of  sky-blue  kersey 


IMG.  89. —  Dress  trousers  for 
all  enlisted  men. 


FIG.  90. —  Service  breeches,  olive- 
drab  wool,  foot. 


CLOTHING    AND    UNIFORM. 


429 


(Fig.  89).  The  service  coat  is  a  single-breasted  sack  coat  of  olive- 
drab  woolen  material  (Fig.  91),  or  olive-drab  washable  cotton 
material  (for  hot  weather),  with  plain  patch  pockets,  and  buttons 
and  collar  ornaments  of  dull-finished  bronze  metal.  The  service 
breeches  are  of  the  same  materials,  made  loose  above  but  fitting 
closely  below  the  knee,  extending  to  the  tops  of  the  shoes  and 
fastened  with  tapes  (Fig.  90).  They  should  always  allow  free  and 
complete  flexion  of  the  knee.  They  are  worn  with  shoes  and 
leggins.  For  mounted  men  they  are  reinforced  with  a  piece  of  the 
same  material  inside  the  thighs,  and  the  lacing  is  on  the  outside 
instead  of  in  front. 

Long  service  trousers  (cotton  or  woolen),  worn  without  leggins, 
are  only  issued  to  enlisted  men  on  duty  in  offices. 

The  service  uniform  has  now  been  used  several  years  under 
various  conditions  of  service  and  climate,  and  has  proved  very 
satisfactory. 

The  cotton  khaki,  formerly  used  for  the  service  uniform,  has 
been  replaced  by  an  olive-drab  cotton  cloth  said  to  be  greatly  pref- 
erable, being  dyed  in  the  raw  cotton  so  that,  when  woven,  its 
softness  and  permeability  are  not  impaired.  It  is  also  lighter  (the 
uniform  weighing  about  10  ounces  less)  as  well  as  stronger  and 
more  serviceable.  The  dye  is  absolutely  fast  so  that  the  cloth  can 
be  washed  repeatedly  without  fading.  It  absorbs  more  heat  than 


FIG.  91. —  Service  coat,  olive-drab  wool,  for  all  enlisted  men. 


43O  MILITARY    HYGIENE. 

the  lighter-hued  khaki  and  is  therefore  somewhat  warmer,  but  is 
much  less  conspicuous.  Furthermore,  khaki  was  of  such  an  un- 
stable color  that  a  company  in  that  cloth  presented  few  uniforms  of 
exactly  the  same  shade  or  hue. 

In  laundering  the  olive-drab  cotton  cloth,  the  clothing  should  be 
washed  in  cold  or  lukewarm  water,  and  no  starch  used.  In  ironing, 
a  woolen  cloth  should  be  interposed,  or  the  uniform  ironed  on  the 
reverse  side. 

The  hospital  corps  when  on  duty  in  hospital,  the  members  of  the 
general  recruiting  service,  in  summer,  as  well  as  cooks  and  bakers, 
wear  white  suits,  coat,  trousers  and  cap,  of  bleached  cotton  duck, 
each  cap  provided  with  two  detachable  covers  for  washing. 

A  fatigue  suit,  coat,  trousers  and  hat,  of  brown  cotton  duck 
(denim),  is  issued  to  all  enlisted  men  for  use  when  on  fatigue  work 
or  certain  special  duties. 


FIG.  92. 


The  olive-drab  flannel  shirt  (Fig.  92)  and  the  szveater  are  also 
parts  of  the  service  uniform.  The  former  may  be  prescribed 
without  the  coat  and  without  the  sweater  as  the  normal  outer  gar- 
ment for  field  service,  recent  tests  under  all  weather  conditions 
having  shown  it  to  be  highly  satisfactory ;  a  belt  is  then  worn 
instead  of  suspenders.  The  insignia  are  worn  on  both  sides  of  the 
collar,  but  the  chevrons  of  non-commissioned  officers  are  on  the 
sleeve. 


CLOTHING    AND    UNIFORM. 


431 


The  sweater  is  designed  to  replace  the  blouse  for  field  use,  being 
a  much  more  comfortable  garment  to  sleep  in  when  necessary,  and 
when  the  weather  is  too  cold  for  the  flannel  shirt  alone,  especially 
on  the  march.  It  has  a  standing  collar  and  two  pockets  in  front 
knitted  into  the  fabric.  It  is  neat  and  not  unsoldierly  in  appearance. 
When  worn  over  the  flannel  shirt  the  collar  of  the  latter  is  made 
to  cover  that  of  the  sweater.  The  insignia  of  rank  of  non-com- 
missioned officers  are  worn  on  the  sleeve.  It  is  carried  in  the 
surplus  kit  bag. 

The  overcoat  for  all  enlisted  men  is  a  double-breasted  ulster  of 
olive-drab  woolen  material,  suitably  lined,  extending  down  the  legs 
8  to  10  inches  below  the  knee,  with  standing  rolling  collar,  and 
closing  by  means  of  five  large  horn  buttons  (Fig.  93).  A  hood 


FIG.  93. —  Overcoat,  olive-drab  wool,  for  all  enlisted  men. 


432  MILITARY    HYGIENE. 

of  the  same  material,  large  enough  to  cover  head  and  cap,  can  be 
buttoned  around  the  neck,  under  the  collar,  so  that  when  drawn 
over  the  head  it  raises  and  holds  the  collar  against  the  neck;  in 
garrison  it  is  worn  only  in  inclement  weather.  The  front  corners 
of  the  skirt  are  provided  with  buttons  or  hooks,  so  that  they  may 
be  turned  back  to  facilitate  marching.  This  overcoat  can  be  worn 
over  any  uniform  without  change  of  head-gear. 

The  Infantry  Equipment  Board  of  1912,  recommended  that  foot 
soldiers  in  the  field  should  wear  a  short  overcoat  extending  about 
half  way  to  the  knee,  on  the  ground  that  long  skirts  are  in  the  way 
and  possess  no  advantage  in  providing  warmth  that  cannot  be  better 
obtained  by  warm  underclothing.  This  recommendation  has  not 
been  approved. 

A  blanket-lined  or  fur-lined  canvas  overcoat  is  issued  to  troops 
stationed  in  extremely  cold  regions,  but  only  for  use  while  on  guard 
duty  or  in  field  service.  Mackinaw  coats  and  trousers,  of  thick 
navy-blue  mackinaw  cloth,  lined  with  dark-blue  flannel,  are  issued 
for  service  in  Alaska. 

Waterproofing.  - —  Garments,  when  dry,  prevent  the  loss  of  body 
temperature  but,  when  wet,  increase  it,  often  to  a  considerable 
degree.  Thus,  wet  woolen  flannel  loses  ^  more  of  its  heat  than 
when  dry,  and  cotton  cloth  %.  This  increased  loss  of  body  heat  is 
the  result  of  the  greater  conductivity  of  the  water  which  has  replaced 
the  air  in  the  interstices  of  the  fabric,  the  expulsion  of  the  warm 
layers  of  air  from  between  the  articles  of  clothing  and,  lastly,  of 
the  greatly  increased  evaporation. 

Furthermore,  the  clinging  of  the  undergarments  to  the  skin  stops 
the  circulation  of  air  upon  its  surface  and,  therefore,  the  excretion 
and  evaporation  of  the  sweat.  It  follows  that  wet  garments  are 
colder  in  winter  and  more  oppressive  in  summer.  They  also  become 
much  heavier,  sometimes  nearly  doubling  in  weight;  thus  the  over- 
coat alone  will  take  up  5  or  6  pounds  of  moisture  in  an  ordinary 
shower.  As  a  consequence,  the  burden  of  the  soldier  is  much  in- 
creased and  his  movements  impeded. 

In  view  of  the  extent  to  which  rain  may  impair  the  efficiency  of 
the  soldier  it  seems  desirable  that  his  uniform  should  be  rendered 
waterproof.  This,  however,  must  be  done  without  impairing  the 
permeability  of  the  fabrics  to  air,  in  this  respect  assimilating  them 
to  the  fleece  of  sheep  or  the  feathers  of  birds  which  exclude 


CLOTHING   AND   UNIFORM.  433 

moisture  while  retaining  a  free  air  circulation.  The  waterproofing 
of  the  uniform  in  a  practical  way,  and  with  permanent  results  is  a 
difficult  problem  and  it  is  very  doubtful  whether  it  can  be  accom> 
plished  without  increase  of  weight  and  sacrifice  of  permeability. 
It  seems  preferable  to  preserve  this  most  important  quality  of 
permeability  at  all  times  and  provide  an  impervious  outer  covering 
for  use  in  rainy  weather.  In  our  service  the  question  has  been 
decided,  and  apparently  wisely,  by  the  issue  of  a  "  poncho  "  to  the 
foot  soldier  and  a  "  slicker"  to  the  mounted  man  (see  page  468). 
These  articles  do  not  add  much  to  the  weight  of  the  pack  and  are 
otherwise  valuable  in  protecting  the  soldier  from  direct  contact  with 
damp  soil  in  camps  and  bivouacs. 

Should  it  be  deemed  advisable,  under  special  circumstances,  to 
waterproof  the  outer  clothing,  at  least  temporarily,  various  prep- 
arations have  been  recommended.  Among  the  best  is  that  of 
Cathoire  who  combines  two  parts  of  paraffin  with  one  part  of  vaseline 
and  dissolves  25  grams  of  the  mixture  in  a  liter  of  naphtha  or  benzin. 
Another  and  simpler  preparation  is  a  10  per  cent,  solution  of  lanolin 
(freed  from  water)  in  benzin,  the  cloth  being  soaked  in  it  and  then 
passed  through  rollers  to  remove  the  excess  of  solution  and  insure 
evenness  of  impregnation.  (Munson.) 

Underclothing.  —  According  to  the  necessities  of  the  climate  and 
service,  enlisted  men  are  provided  with  two  kinds  of  undershirts, 
wool  knit  (half  wool  and  half  cotton)  and  cotton  knit;  two  kinds 
of  drawers,  unbleached  canton  flannel  (Fig.  94),  and  jean  (Fig.  95)  ; 
three  kinds  of  overshirts,  olive-drab  flannel  (Fig.  92),  heavy  and 
light,  and  white  muslin ;  two  kinds  of  stockings,  woolen  and  cotton. 
When  the  coat  is  not  put  on,  the  olive-drab  flannel  overshirt  is  worn 
as  part  of  the  service  uniform,  as  noted  above.  In  Alaska,  fleece- 
lined  undershirts  and  drawers* are  likewise  supplied.  A  blue-and- 
white  chambray  overshirt  is  also  issued,  but  will  be  discontinued 
after  the  stock  on  hand  has  become  exhausted.  Pajamas  have  also 
been  removed  from  the  list  of  clothing. 

In  emergency,  paper  is  useful,  plastrons  of  one  or  two  thicknesses 
of  newspaper  being  placed  over  the  chest.  Paper  soles  within  the 
shoes  may  also  prevent  much  discomfort. 

Head  Covering.  —  The  covering  for  the  head  should  be  light  in 
weight,  well  ventilated,  and  a  bad  heat  conductor;  it  should  also 
protect  the  head  from  heat  and  cold,  shield  the  eyes  in  front  and 


434 


MILITARY    HYGIENE. 


the  back  of  the  neck  from  sun  and  rain.  It  should  have  a  firm, 
even  hold  of  the  head  so  as  not  to  be  easily  blown  off,  but  without 
constriction  at  any  point ;  in  other  words,  it  should  have  the  contour 
of  the  average  head  which  is  oval  or  elliptical  and  not  circular. 
Good  ventilation  is  assured  by  providing  plenty  of  space  between 
the  scalp  and  the  top  of  the  covering-  and  a  free  circulation  of  air 


FIG.  94. —  Winter  drawers  of 
canton  flannel. 


FIG.  95. —  Summer  drawers  of  jean. 


through  it.  The  ventilating  holes  should  be  preferably  in  front  and 
rear  rather  than  on  the  sides,  so  as  to  set  the  air  in  circulation  by 
the  motion  of  the  wearer.  The  head-dress,  more  than  any  other 
part  of  the  clothing,  must  be  non-actinic,  that  is,  exclude  the  short 
ultra-violet  rays ;  this  is  best  accomplished  by  black  or  orange  lining, 
good  ventilation  and  absence  of  constriction  of  the  scalp. 


CLOTHING    AND   UNIFORM.  435 

The  head-gear  which,  in  a  hot  country,  best  combines  these  require- 
ments, is  a  properly  constructed  waterproof  pith  helmet,  of  white 
color,  with  ample  brim  in  front  and  rear,  and  an  all-round  ventilated 
sweat  band.  The  lining  should  be  black  inside  the  body  and  dark 
blue  or  green  inside  the  brim. 

Experiments  made  in  the  Philippines  have  shown  that  while  the 
temperature  inside  a  white  helmet  was  35.36°  C.  (or  always  below 
the  body  temperature),  it  rose  to  38.38°  in  a  khaki  helmet,  to  40.42° 
in  an  olive-drab  helmet  and  to  46.60°  in  the  campaign  hat. 

The  ideal  tropical  helmet  is  one  made  up  of  two  shells,  one  within 
the  other,  with  complete  air  space  between.  The  use  of  aluminum 
or  tin-foil  is  not  to  be  recommended  as  metals  are  good  heat  con- 
ductors  and  interfere  with  air  permeability.  Felt  or  cork  may  be 
used  instead  of  pith,  but  cork,  if  thick  enough,  is  too  heavy.  The 
objections  to  the  helmet,  especially  for  the  use  of  enlisted  men, 
are  its  bulk,  its  stiff,  unyielding  material,  and  the  ease  with  which 
it  gets  broken  or  damaged,  or,  if  not  waterproof,  softened  by  rain. 

The  only  kind  authorized  in  our  service  is  the  olive-drab,  worn 
by  troops  in  the  Philippines  when  in  garrison,  the  service  hat  being 
worn  at  other  times.  The  superiority  of  the  white  helmet,  in  hot 
weather,  as  a  comfortable  and  hygienic  head  covering,  has  been  so 
clearly  shown  that  there  seems  to  be  no  good  reason  why  it  should 
not  be  used  on  garrison  duty  in  the  tropics  and  in  the  Southern 
States.  Even  when  worn  with  the  olive-drab  uniform  the  contrast 
in  color  is  not  at  all  unpleasant. 

The  "  havelock,"  a  piece  of  muslin  hanging  loose  from  the  rear 
border  of  the  helmet,  protects  the  neck  from  the  sun ;  but  this  is 
more  effectively  done  by  a  sufficiently  wide  brim. 

Caps.  —  Enlisted  men  are  provided  with  a  dress  cap,  a  service 
cap,  a  service  hat,  and  a  fatigue  hat  (denim).  The  dress  cap  (Fig. 
96)  is  of  dark-blue  cloth,  with  flared  top,  stiffened  in  front  and 
projecting  all  around  from  three-quarters  to  an  inch  beyond  the 
band.  The  flat  crown,  slightly  oval  in  outline,  is  held  firm  by  wire 
springs  and  slopes  down  in  rear.  Its  total  height  is  4  inches.  The 
visor,  of  solid  patent  leather,  lined  with  embossed  green  leather,  is 
i^i  inch  wide  at  its  center  and  slopes  at  an  agle  of  45  degrees.  It 
is  ventilated  by  two  eyelets  on  each  side  and  one  in  front,  of  l/s 
inch  aperture.  In  the  front  eyelet  are  inserted  the  fastenings  of 
the  detachable  gilt  insignia.  It  has  a  detachable  band  for  occasions 
of  ceremony  varying  in  color  according  to  the  arm  of  the  service. 


436 


MILITARY    HYGIENE. 


The  service  cap  (Fig.  97)  is  of  olive-drab  woolen  material,  but 
otherwise  like  the  dress  cap  in  size,  form  and  construction.  It  takes 
a  firm  grasp  of  the  head  without  irksome  pressure  and  is  light  and 
comfortable.  From  the  viewpoint  of  hygiene,  it  would  be  improved 
by  raising  the  slanting  crown  to  a  level  so  as  to  increase  its  air  space, 
and  widening  the  visor  to  2  or  even  2^2  inches,  the  better  to  protect 
eyes  and  face.  Like  all  caps  and  kepis,  it  has  the  defect  of  not 
protecting,  or  only  imperfectly,  the  nape  of  the  neck.  It  is  not  worn 
in  the  Philippines,  being  unsuitable  for  warm  countries. 


FIG.  96. —  Dress  cap  for  all  enlisted  men. 


Service  Hat.  —  The  service  or  campaign  hat  (Fig.  98)  is  of  drab 
felt,  as  near  as  possible  the  color  of  the  service  uniform,  practically 
waterproof,  with  stiff  brim  3  inches  wide,  and  soft  crown  $y2  inches 
high;  to  be  worn  peak  fashion  by  making  four  slight  indentations 
between  the  ventilating  eyelets.  Ventilation  is  obtained  by  four 
eyelets  3/16  inch  wide,  one  in  front,  rear  and  on  each  side.  It  is 


FIG.  97. —  Service  cap  for  all  enlisted  men,  olive-drab  serge. 


CLOTHING    AND   UNIFORM. 


437 


FIG.  08. — •  Service  or  campaign  hat. 


FIG.  99. —  Leather  gauntlets  for  mounted  men. 


438 


MILITARY    HYGIENE. 


held  by  a  braided  cord  passed  over  the  back  of  the  head.  To  the 
leather  sweatband,  1^4  inches  wide,  is  attached  a  non-rustible  reed 
covered  with  an  oiled  muslin  backing. 

It  is  a  very  serviceable  headgear,  protecting  also  the  face,  temples 
and  nape  of  the  neck,  with  larger  air  space  and  better  ventilation 
than  the  cap.  Its  softness  and  flexibility  allow  of  rough  usage  in 
the  field  without  rendering  it  unserviceable ;  in  this  lies  its  superior- 
ity over  the  helmet.  Creasing  the  crown  reduces  the  air  space  and 
therefore  is  not  advisable.  A  wet  cloth  may  be  placed  within  it  to 
cool  the  head. 

The  recommendations  of  the  Infantry  Equipment  Board  of  1912, 
that  the  brim  be  3^/2  inches  wide,  and  that  a  ventilating  cork  pad  be 
placed  under  the  sweatband  in  front,  are  judicious.  Some  such  de- 


FIG.  100. —  Olive-drab  woolen  glove. 


CLOTHING    AND   UNIFORM. 


439 


vice  to  permit  the  air  to  circulate  freely  around  the  head  is  highly 
desirable,  at  least  in  warm  regions.  The  cord,  when  used  around 
the  back  of  the  head,  is  uncomfortable  and  not  effective  in  keeping 
the  hat  on.  A  recent  regulation  directs  that  "  the  hat  strings  pro- 
vided on  service  hats  will  be  used,  tied  either  under  the  chin  or  as 
chin  straps  on  the  point  of  the  chin." 

In  very  cold  regions,  canvas  caps  lined  with  olive-drab  kersey, 
which  cover  the  head  and  neck,  may  be  issued  to  enlisted  men ;  this 
takes  the  place  of  the  former  fur  cap  now  only  allowed  in  Alaska. 

A  worsted  knitted  cap,  light  weight,  has  also  been  recommended 
by  the  Infantry  Equipment  Board  of  1912,  for  use  in  climates  re- 
quiring it,  to  be  worn  at  night,  or  over  the  ears  under  the  hat  on  the 
march.  It  is  to  be  carried,  normally,  in  the  pocket  of  the  overcoat 
or  sweater. 

Gloves.  —  The  gloves  issued  are :  leather  gauntlets  for  mounted 
duty  (Fig.  99)  ;  leather  gloves  for  men  of  the  coast  artillery  and 
ordnance  department,  to  protect  their  hands  when  handling  guns; 
white  cotton  or  olive-drab  woolen  gloves  (Fig.  100),  for  dismounted 
duty;  thick  buckskin  mittens  (admitting  woolen  gloves  inside)  or 
fur  mittens  (Fig.  101)  for  very  cold  regions. 


FIG.  101. —  Fur  mittens,  fleece-lined. 


44O  MILITARY    HYGIENE. 

Abdominal  Band.  —  The  woolen  abdominal  band,  formerly  highly 
recommended  in  the  tropics,  may  be  occasionally  useful  in  the  case 
of  men  predisposed  to  gastric  or  intestinal  disturbances,  but  should 
only  be  worn  at  night  and  when  the  abdomen  is  not  otherwise  suit- 
ably protected.  It  is  no  longer  issued.  When  the  bowels  need 
special  protection,  the  triangular  apron  advocated  by  Woodhull  is 
preferable  to  the  band.  It  consists  of  two  thicknesses  of  flannel 
sewn  together,  and  is  suspended  from  a  tape  tied  around  the  waist 
r/see  page  704). 


CHAPTER  XXXVI. 
UNIFOEM  (CONTINUED). 

FOOT-WEAR. 

In  warfare,  the  chief  aim  of  the  commanding  general  is  to  occupy 
advantageous  positions  with  the  greatest  possible  number  of  men  in 
the  shortest  possible  time.  This  is  largely  governed  by  the  marching 
capacity  of  the  men  which,  in  its  turn,  depends  to  a  great  extent 
upon  their  foot-wear,  for  this,  according  to  Marshal  Niel,  is  to  the 
infantry  what  horses  are  to  the  cavalry.  It  has  been  observed  in 
the  French  maneuvers  that,  in  the  first  few  days,  15  per  cent,  of  the 
infantry  have  their  feet  more  or  less  injured  by  ill-fitting  shoes.  In 
1883,  Von  Lindau  estimated  that,  in  Germany,  there  were,  each  year, 
60,000  conscripts  exempted  from  service  on  account  of  disability 
produced  by  foot-wear.  It  has  been  estimated  that  an  average  loss 
of  10  per  cent,  must  be  expected  from  this  cause  in  European 
armies,  among  unseasoned  troops  on  taking  the  field.  Therefore 
the  importance  of  well-fitting,  comfortable  .and  serviceable  shoes 
cannot  be  overestimated.  Each  man  should  watch  his  shoes  and 
do  such  precautionary  mending  as  he  is  able,  to  save  them  from 
becoming  unserviceable,  or  else  take  them  to  the  company  shoemaker 
who,  on  the  march,  should  have  his  tools  and  materials  carried  in 
the  company  wagon  or  advance  train. 

Before  determining  the  most  suitable  covering  for  the  foot  it  is 
necessary,  first,  to  know  something  about  its  anatomical  lines*.  The 
foot  is  remarkable  for  its  lack  of  symmetry  from  whichever  side  it 
is  looked  at.  The  plantar  surface  is  distinctly  arched  lengthwise 
and  also,  but  more  slightly,  from  side  to  side,  a  structure  which  com- 
bines strength  with  elasticity.  The  arching  is  greatest  on  the  everted 
internal  border  and  disappears  on  the  external  border  which  touches 
the  ground.  In  the  standing  posture,  the  foot  rests  on  the  heel,  the 
head  of  the  first  metatarsal  bone  (ball  of  the  big  toe)  and  the  outside 
border.  In  a  normal,  well-shaped  foot,  the  internal  border  is  prac- 
tically straight,  that  is  to  say,  if  placed  side  by  side,  the  feet  will 
touch  each  other  from  heel  to  tip  of  big  toe,  the  shallow  lateral  curve 
of  the  arch  excepted.  (Fig.  102.)  According  to  Meyer :  "  The  great 

441 


442 


MILITARY    HYGIENE. 


toe  must  lie  in  such  a  position  that  its  axis,  when  carried  backward, 
shall  pass  through  the  center  of  the  heel."  This  "  Meyer  line  "  is 
now  generally  accepted  as  practically  correct.  (Fig.  103.)  The  ex- 
ternal border,  on  the  contrary,  describes  a  marked  curve,  from  the 


FIG.   102.  —  The  normal   foot  and   foot- 
print.    (Munson.) 


FIG.  103. —  The  normal 
foot.  A-B,  Meyer's  line ; 
C-D,  ball  line. 


tip  of  the  big  toe  (the  longest  of  the  toes)  outward  along  the  reced- 
ing toes,  the  summit  of  the  convexity  being  opposite  the  base  of  the 
little  toe.  The  widest  part  of  the  foot  is  an  oblique  line  drawn  from 
the  base  of  the  big  toe  to  that  of  the  little  toe  (ball  line).  It  is  to  be 
noted  that  the  ridge  of  the  instep  does  not  run  along  the  middle  line 
of  the  foot  but  inside  of  it  and  toward  the  big  toe. 

A  badly-shaped  shoe,  or  one  too  short  or  too  narrow,  produces  a 
misshapen  foot  and  various  lesions  which  seriously  impair  the  effi- 
ciency of  the  soldier,  such  as  corns,  callosities,  jamming  and  club- 
bing of  toes,  ingrowing  nails ;  some  of  the  distal  phalanges  become 
bent  down  (hammer  toes).  Most  commonly  the  toes  are  crowded 
toward  the  middle  line,  the  second  and  third  overriding  the  others, 
while  the  big  toe,  not  infrequently,  is  partly  dislocated  at  the  meta- 
tarso-phalangeal  articulation,  which  may  swell  into  a  bunion.  This 
displacement  and  deformity  of  the  toes  deprive  the  foot  of  much  of 


UNIFORM   (CONTINUED). 


443 


its  propulsive  power  in  walking.  It  must  also  be  borne  in  mind  that 
any  interference  with  the  full  play  of  the  arch  by  tight  shoes  not  only 
impairs  the  efficiency  of  the  foot  but  greatly  increases  the  fatigue  of 
the  march  by  the  more  direct  transmission  of  the  jar  of  the  step  to 
the  body.  Soreness  of  feet  from  any  cause  will  also  make  the 


FIG.  104. —  Radiograph  of  foot  of  sol- 
dier, showing  hallux  valgus  and  clubbed 
toes  due  to  bad  shoes.  (Munson.) 

sufferer  bring  into  action  unusual  muscles  in  order  to  diminish  the 
movement  or  pressure  which  produces  pain,  thus  adding  another 
cause  of  muscular  effort  and  fatigue. 

Hallux  valgus  is  the  name  given  to  the  very  common  condition 
described  above,  in  which  the  great  toe  is  pushed  away  from  its 


444  MILITARY    HYGIENE. 

proper,  straight  inner  line  (Fig.  104),  its  two  phalanges  making  a 
marked  angle  with  the  first  metatarsal.  The  big  toe  is  such  an 
important  part  of  the  foot  that  its  displacement,  if  more  than  slight, 
has  a  very  appreciable  effect  upon  the  soldier's  ability  to  stand  and 
walk,  while,  if  considerable,  it  may  constitute  a  cause  for  rejection 
in  applicants  for  enlistment. 

The  Meyer  line  is  only  seen  in  the  perfect  foot,  that  is,  in  the  foot 
of  children  and  of  adults  who  have  never  worn  shoes.  In  all  civil- 
ized, shoe-wearing  people,  the  big  toe  is  more  or  less  pushed  out  of 
line,  so  that  a  certain  degree  of  hallux  valgus  has  come  to  be  re- 
garded as  practically  normal  and  must  be  given  due  consideration 
in  the  construction  of  the  shoe  last,  so  that  there  be  no  loss  of  space 
or  excess  of  material  in  the  shoe. 

Munson  has  called  attention  to  the  fact  that  there  is  a  military 
foot  type,  distinct  from  the  average  civilian  foot,  that  is  to  say,  a 
better-shaped,  stronger,  more  stocky  and  muscular  foot;  a  diffe,r- 
ence  due,  in  the  first  place,  to  the  selection  of  the  recruit,  and  to  the 
active  marching  exercise  to  which  he  is  subjected.  The  military 
shoe,  therefore,  requires  a  special  last,  one  that  follows  more  strictly 
the  anatomical  lines  of  a  normally  and  strongly  developed  foot. 

The  foot  should  be  measured  while  standing,  for  the  mere  weight 
of  the  body  causes  it  to  spread  1/3  inch  in  length  and  1-5  inch  in 
width,  while,  under  a  heavy  weight,  such  as  the  soldier  may  carry 
in  the  field,  the  elongation  may  reach  at  least  half  an  inch  and  the 
widening  at  least  a  quarter  inch.  After  a  long  march  the  whole 
foot  becomes  still  further  temporarily  enlarged.  In  the  tropics, 
according  to  Giles,  the  feet  (as  well  as  the  hands)  become  a  full 
size  larger  than  at  home. 

But  little  benefit  would  result  from  a  well-constructed  shoe  unless 
carefully  fitted  to  each  individual  foot.  This  fitting  is  considered  so 
important  that  the  Q.  M.  Corps  is  required  to  provide  15  lengths  of 
shoes,  running  from  5  to  12  by  half  sizes,  each  length  with  6  widths ; 
in  all,  90  sizes. 

Experience  has  shown  that  very  few  soldiers  know  how  to  select 
suitable  shoes,  such  as  will  enable  them  to  march  for  a  number  of 
days  with  comfort  and  without  injury  to  any  part  of  the  foot. 
Their  chief  aim,  like  most  young  men  in  civil  life,  is  to  obtain  the 
smallest  size  that  will  permit  them  to  walk.  Therefore,  under  exist- 
ing regulations,  the  company  commander  is  required  personally  to 


UNIFORM  (CONTINUED).  445 

measure  the  feet  and  fit  the  shoes  of  men  of  his  company.  All 
measurements  are  taken  with  the  soldier  standing  in  bare  feet  and 
with  a  4O-pound  burden  on  his  back,  bearing  the  entire  weight  upon 
the  foot  to  be  measured.  To  the  actual  length  of  the  foot  thus 
obtained,  two  sizes  are  added  (2/3  of  an  inch),  to  provide  space  for 
the  socks  and  for  the  free  play  and  congestion  of  the  foot.  The 
circumference  of  the  foot  is  taken  with  the  measuring  tape  around 
the  ball.  To  verify  the  fitness  of  shoes,  the  soldier  having  put  them 
on,  over  light  woolen  socks,  and  laced  them  tightly,  is  made  to  stand 
squarely  on  each  foot,  supporting  himself  and  his  load  so  as  to 
maintain  easy  equilibrium.  Fitness  in  length  is  ascertained  by  press- 
ing down  the  leather  in  front  of  the  great  toe,  where  there  should 
be  no  less  than  half  an  inch  of  vacant  space.  'Fitness  in  width  is 
verified  by  grasping  the  vamp  of  the  shoe  at  its  widest  part  and 
bringing  the  thumb  and  fingers  slowly  together;  the  leather  should 
not  be  so  loose  as  to  wrinkle,  nor  should  it  feel  hard,  tense  and 
bulging. 

A  suitable  fit,  especially  in  width,  may  require  several  trials  before 
entirely  satisfactory  shoes  are  secured.  The  guiding  principle  in 
this  fitting  is  that  shoes  larger  than  necessary  seldom  do  any  harm, 
whereas  it  is  short  and  narrow  shoes  which  cause  the  vast  majority 
of  injuries.  Shoes  of  the  proper  length  and  width,  but  which  are 
not  wholly  comfortable,  are  eased  by  the  application  of  the  shoe 
stretcher  provided  by  the  Q.  M.  Corps.  A  free  use  of  this  stretcher 
in  the  shoes  just  selected  is  nearly  always  advisable.  By  means  of 
adjustable  bulbs,  stretching  of  such  local  areas  as  are  especially 
liable  to  cause  friction,  blisters  or  corns  is  easily  accomplished. 

With  the  few  men  who,  on  account  of  anatomical  peculiarities, 
are  obliged  to  wear  somewhat  too  loose  shoes  in  marching,  the 
Coindreau  strap,  as  used  in  the  French  army,  is  recommended.  It 
is  3  mm.  thick,  15  mm.  wide,  and  75  centimeters  long.  It  is  passed 
under  the  foot,  crossed  over  the  instep,  passed  around  above  the 
heel  and  buckled  on  the  outside  of  the  foot,  .above  and  in  front  of 
the  ankle,  thus  describing  a  figure  of  eight.  This  strap  keeps  the 
shoe  from  slipping  and  prevents  chafing. 

According  to  Munson,  an  excellent  method  of  moulding  the  shoes 
to  the  feet,  after  careful  fitting,  consists  in  making  the  man,  with 
shoes  on,  stand  in  about  three  inches  of  water  for  about  five  minutes, 
or  until  the  leather  is  thoroughly  wet  and  pliable.  He  then  walks  on 


446 


MILITARY    HYGIENE. 


a  level  surface  for  about  an  hour,  or  until  the  shoes  have  dried  on  his 
feet.  .This  method  is  particularly  valuable  where  troops  are  issued 
new  shoes  which  there  is  no  time  to  break  in  slowly,  before  they 
must  be  used  for  marching. 

It  has  been  observed  that  the  foot  of  a  recruit  put  in  the  Army 
shoe  tends  to  broaden,  thicken  and  strengthen,  so  that  another  fitting 


FIG.  105.  —  Shape  of  new  military 
shoe.  Insoles  placed  side  by  side. 
A-B,  Meyer's  line  as  it  would  be  in 
perfect  foot  with  straight  inner  bor- 
der, but  slightly  deviated  outward,  as 
shown  by  dotted  line,  in  the  military 
shoe  so  as  to  fit  the  average  sound  foot. 

may  be   needed   six   months   later.     Thereafter  the   soldier's   size 
remains  a  constant  quantity  for  future  requisitions. 

Inasmuch  as  the  rational  shoe  must  follow  the  lines  and  contours 
of  the  foot  it  follows  that  instead  of  having  a  symmetrical  rounded 
tip,  with  apex  in  the  middle  line,  it  should  be  broadly  triangular, 
with  the  apex  of  the  triangle  opposite  the  big  toe,  the  internal  side 
slightly  slanting  outward  from  the  ball  of  the  big  toe,  while  the 
external  side  is  well  curved  around  the  toes.  In  theory,  as  already 
explained,  the  inner  edge  of  the  big  toes  should  be  straight,  that  is, 


UNIFORM   (CONTINUED).  447 

parallel  with  the  Meyer  line,  but  as  the  adult  foot  is  never  perfectly 
normal  in  this  respect,  the  big  toe  being  always  deflected  more  or  less 
outward,  the  shape  adopted  in  the  new  military  shoe  and  illustrated 
in  Fig.  105  is  practically  anatomical.  In  the  narrow  part  (shank) 
of  the  sole,  the  concavity  of  the  inside  border  is  more  marked  than 
on  the  outside,  corresponding  to  the  everted  form  of  the  arch. 
Laced  shoes  which  permit  to  vary  the  degree  of  tightness  are 
preferable. 

The  requisites  of  a  good  military  shoe  may  oe  summed  up  as 
follows  :* 

It  should  be  strong  and  substantial,  yet  sufficiently  flexible,  the 
upper  and  quarter  being  as  soft  and  yielding  as  compatible  with  hard 
service.  It  must  be  comfortable,  by  proper  shape,  careful  fitting 
and  suitable  material.  It  must  be  durable  by  making  the  soles  as 
thick  and  strong  as  the  leather  permits,  and  having  half  soles  at  hand 
to  be  attached  as  required.  In  sandy  and  rocky  regions  brass- 
screwed  or  hobnailed  soles  are  preferable.  Box  toes  have  been  left 
off  our  military  shoe  on  account  of  the  serious  defect,  when  wet  and 
then  drying  off  the  feet,  of  warping  and  curving  down  so  as  to  press 
on  the  toes;  they  are  replaced  by  a  double  thickness  of  leather 
forming  a  toe  cap ;  this  must  be  high  so  as  to  avoid  pressure  on  the 
toes  from  above,  and  must  rise  abruptly  from  the  front  of  the  shoe ; 
as  it  is  soft  and  pliable  it  expands  where  space  is  most  needed. 

The  shoe  must  be  as  light  as  is  compatible  with  durability.  Viry 
is  responsible  for  the  statement  that  every  additional  ounce  carried 
on  the  shoe  is  equivalent,  as  regards  effect  on  the  wearer,  to  100 
ounces  carried  on  the  back.  This  additional  weight  has  not  only  to 
be  carried,  but  lifted  a  height  of  340  feet  in  every  mile.  Our 
army  shoe  weighs  only  2  pounds  5  ounces,  without  nails,  while  the 
thickly  hob-nailed  French  shoe  weighs  3-)4  pounds.  According  to 
Corbusier  it  would  seem  advisable,  under  certain  conditions,  "  to 
use  a  medium-sized  hob-nail  on  the  marching  shoe,  as  the  rough- 
ened surface  prevents  wear  and  slipping,  both  in  muddy  ground 
and  on  hard  roads." 

The  shoe  must  be  easily  put  on  and  taken  off ;  to  this  end  the 
new  shoe  has  a  wide  half-bellows  tongue  and  only  six  eyelets  on 
each  side,  or  seven  when  the  size  exceeds  No.  8.  Eyelets  and  not 
hooks  are  used  for  the  laces.  The  heel  should  be  broad,  flat  and 

*  The  Soldier's  Foot  and  the  Military  Shoe.     E.  L.  Munson,  U.  S.  Army. 


448  MILITARY    HYGIENE. 

long;  as  the  outer  edge  tends  to  wear  more  rapidly  than  the  inner 
part,  it  should  be  heavily  reinforced  with  nails.  The  stability 
of  the  foot  is  secured  by  a  snug  fit  over  the  instep  and  around  the 
ankles  and  heel;  at  these  points  the  contact  with  the  foot  must  be 
firm  to  prevent  slipping  and  wabbling,  the  posterior  wall  curving 
and  narrowing  so  as  to  embrace  the  natural  curvature  of  the  heel. 
The  sole  is  flat  across  but  has  a  slight  upward  curve  at  its  front  end 
to  prevent  the  toe  from  striking  stones  or  sinking  in  the  mud,  and 
also  to  facilitate  the  heel-and-toe  movement  of  the  marching  step. 

To  form  a  more  complete  idea  of  the  requirements  of  foot-wear, 
we  must  also  bear  in  mind  a  physiological  peculiarity  of  the  foot, 
namely,  its  abundant  excretion  of  sweat,  the  amount  poured  out  by 
both  feet  being  estimated  at  one-fourth  of  the  total  quantity  ex- 
creted by  the  skin  surface  covered  with  clothing.  The  permeability 
of  leather,  permitting  the  evaporation  of  the  sweat,  is  therefore  a 
desirable  quality,  especially  in  hot  weather,  but  this  quality  only 
exists  to  a  limited  extent  and  is  further  diminished  by  the  use  of 
grease.  The  result  is  that  the  perspiration  is  liable  to  accumulate 
inside  the  shoe  and  cause  soaking  and  softening  of  the  skin.  These 
drawbacks  are  reduced  to  a  minimum  by  the  use  of  laced  shoes 
which  leave  openings  for  the  escape  of  the  sweat,  and  of  appropriate 
socks  or  stockings.  Russet-leather  shoes,  prepared  with  vegetable 
tan,  without  coloring  and  filling,  and  only  lightly  oiled,  are  more 
porous  than  black  shoes  and  therefore  preferable  in  summer,  or  at 
any  time  for  marching. 

The  chief  object  of  the  shoe  is  to  protect  the  foot  against  outside 
cold,  moisture  and  mud,  as  well  as  from  injury.  Moisture  in 
leather,  as  in  textile  fabrics,  increases  the  heat  conductivity  and,  in 
cold  weather,  may  chill  the  feet.  Waterproofing,  therefore,  may  be 
occasionally  advantageous  in  certain  conditions  of  climate  and  soil. 
It  is  readily  done  by  the  soldier  himself  by  rubbing  the  dry,  clean 
leather,  slightly  warmed,  with  neatsfood  oil  until  the  proper  degree 
of  saturation  is  reached.  Such  waterproofing  is  not  perfect  nor  per- 
manent, but  can  be  renewed  when  necessary  and  answers  the 
soldier's  purpose.  It  is  better  to  let  the  feet  get  wet  now  and  then 
than  to  keep  them  constantly  hot  and  sweaty  by  interference  with 
the  evaporation  of  perspiration. 

Shoe  blacking  contains  acids  which  harden  and  crack  the  leather. 
In  the  field,  and  in  garrison  when  not  required  to  be  polished,  the 


UNIFORM   (CONTINUED). 


449 


soldier's  footgear  should  be  cleaned,  then  lightly  oiled  or  greased. 
Neatsfoot  oil  is  now  issued  to  enlisted  men  for  the  purpose.  It  is 
the  natural  oil  of  the  animal  and  free  from  substances  deleterious  to 
leather. 

Various  devices  have  been  recommended  to  increase  the  elasticity 
of  the  shoe  and  facilitate  marching  by  the  use  of  rubber  in  the  heel 
and  sole,  but  none  has  as  yet  been  found  sufficiently  practical  and 
durable  for  military  purposes. 


FJG.  1 06. —  Russet  shoes. 

In  our  service,  the  foot-wear  issued  to  enlisted  men  of  all  arms  is 
reduced  to  two  forms,  the  russet  or  tan-leather  shoe  and  the  gymna- 
sium shoe. 


FIG.  107. —  Gymnasium  shoes. 


450  MILITARY    HYGIENE. 

The  russet  shoe  (Fig-.  106)  is  a  laced  shoe,  with  half-bellows 
tongue,  6]/2  inches  high  from  .bottom  of  heel.  It  is  worn  "  for  all 
occasions  "  in  garrison  and  on  the  march.  It  is  polished  with  the 
usual  russet  dressing  in  garrison,  or  oil-tanned  with  neatsfoot  oil 
in  the  field. 

The  gymnasium   shoe    (Fig.   107)    is  a  low  shoe  of  soft  black 


FIG.  108. —  Arctic  overshoes. 


"  vici  "  kid.  It  is  worn  in  gymnasium  work.  It  may  be  worn  in 
barracks  and  may,  when  prescribed  by  the  commanding1  officer,  be 
carried  in  the  surplus  kit  and  used  as  a  camp  shoe. 

Overshoes.  — •  In  extremely  cold  regions,  when  the  necessity  there- 
for is  certified  by  the  post  commander,  arctic  overshoes  (Fig.  108) 
or  lined  moccasins  may  be  issued  to  the  men. 

Leggins.  —  Canvas  leggins  are  worn  by  all  infantry  men  with  the 
service  uniform.  (Fig.  109.)  They  are  of'  cotton  duck,  dyed 
through  in  the  fiber  to  the  proper  olive-drab  shade,  and  fastened 
with  a  round  braided  cord  partly  concealed.  Made  in  five  sizes.  A 
piece  of  tape  stitched  on  the  inside  of  the  back  holds  a  piece  of  lacing 
cord  which  is  fastened  to  the  back  of  the  shoe  to  keep  the  leggin 
from  slipping  up.  According  to  a  recent  decision,  mounted  troops 
are  to  be  supplied  with  leather  leggins  fastened  with  outside  strap 
and  buckle. 


UNIFORM   (CONTINUED;.  451 

The  spiral  "  puttee  "  has  been  recommended  for  our  Army  by 
the  Infantry  Equipment  Board  of  1912.  It  consists  of  a  long  woven 
flannel  or  worsted  bandage  which  is  wound  around  and  supports  the 
leg  from  ankle  to  knee,  requiring  neither  strap  nor  buckle  and  adapt- 
ing itself  perfectly  to  the  shape  of  the  limb.  It  is  lighter  and  more 
easily  cleaned  than  leggins.  It  also  excludes  insects  and  other 
animals  more  completely.  In  spite  of  these  advantages,  a  properly 
made  and  well-fitted  leggin  is  generally  considered  preferable. 

The  abolition  of  the  service  trousers,  and  the  wearing  of  breeches 


' .    ... 


FIG.  109. —  Canvas  Leggin,  for  infantry  men. 

and  leggins  by  all  enlisted  men  and  on  all  duties  (except  for  the 
few  wearing  the  white  duck  uniform),  as  at  first  required,  was  a 
sacrifice  of  comfort  to  appearance,  without  any  compensating  gain 
in  efficiency.  Leggins  thus  constantly  worn  are  liable  to  cause, 
especially  in  warm  climates,  increased  perspiration  of  legs,  a  predis- 
position to  skin  disease  and  more  or  less  interference  with  the  circu- 
lation. Upon  the  recommendation  of  the  Inspector  General,  the 
issue  of  service  trousers  (cotton  or  woolen),  to  be  worn  without 
leggins,  is  now  authorized  for  the  men  of  the  Q.  M.  Corps  when 


452  MILITARY    HYGIENE. 

not  under  arms.     This  desirable  privilege  was  further  extended  by 
the  following  order: 

"  Trousers,  cotton  or  woolen  service,  nay  be  issued  -to  and  worn  'with- 
out leggins  by  such  enlisted  men  as  are  on  duty  in  offices,  in  the  build- 
ings in  which  offices  are  situated,  to  be  worn  only  during  the  time  actually 
engaged  on  such  office  duty." 

Socks.  —  Two  kinds  of  socks  are  issued,  woolen  (heavy  and 
light)  and  cotton.  Woolen  are  in  many  ways  superior  to  cotton 
socks,  having-  greater  compressibility,  elasticity  and  absorbent  power, 
and  are  preferable  for  the  soldier  in  the  field,  provided  their  thick- 
ness can  be  varied  according  to  circumstances.  Cotton  socks  may 
be  worn  in  hot  weather  or  when  wool  provokes  abundant  perspira- 
tion, but  need  frequent  changing.  Each  man  should  be  allowed  to 
wear  the  kind  most  comfortable  to  him. 

Socks,  like  shoes,  should  fit  the  wearer.  If  too  small  they  are  not 
only  painfully  uncomfortable,  but  wear  out  more  quickly  and  help 
to  produce  displacement  and  deformity  of  the  toes.  Allowance  must 
also  be  made  for  the  shrinking  of  woolen  socks  in  washing.  As  a 
rule,  the  soldier  should  wear  socks  one  size  larger  than  the  length 
of  the  foot. 


CHAPTER    XXXVII. 
EQUIPMENT. 

In  the  field,  the  soldier,  besides  the  clothing  he  wears,  carries  arms 
and  accouterments,  ammunition,  extra  clothing  and  toilet  articles, 
intrenching  tools  and  rations,  all  of  which  constitute  his  equipment. 

The  general  requirements  of  the  equipment  are  the  following: 

1.  Reduction  of  weight  to  the  minimum  consistent  with  strength 
and  durability. 

2.  Ease  and  convenience  of  carriage  by  the  proper  suspension  and 
distribution  of  the  load. 

3.  Facility  of  putting  on  and  removal. 

4.  Easy  segregation  and  removal  of  unnecessary  parts  for  march- 
ing and  fighting. 

5.  Simplicity  of  construction  and  ease  of  repair. 

6.  Sanitary  construction,  so  as  to  prevent  fouling  irom  contents, 
and  permit  cleansing  and  renovation. 

To  reduce  the  weight  of  the  equipment  to  the  minimum  necessary 
and  distribute  it  over  the  body  so  as  to  be  most  conveniently  carried 
and  least  impede  the  marching  capacity  of  the  soldier  are  important 
questions  to  which  much  attention  has  been  given.  From  the  experi- 
ments of  Zuntz  and  Shumburg  the  weight  carried  by  the  soldier, 
when  exceeding  certain  limits,  reduces  his  vital  (respiratory)  capac- 
ity to  a  serious  extent,  namely,  9  per  cent,  with  a  load  of  48  pounds, 
and  about  1 1  per  cent,  with  a  load  of  59  pounds.  This  embarrass- 
ment of  respiratory  movements  is  often  followed  by  engorgement  at 
the  bases  of  the  lungs  and  an  increase  in  cardiac  and  hepatic  dul- 
ness.  These  disabling  effects  become  less  marked  after  well-regulated 
practice.  From  other  experiments  carried  out  in  Germany  it  results 
that  the  weight  (including  overcoat)  should  seldom  exceed  55 
pounds,  and  that  a  load  of  65  pounds  is  oppressive  and  exhausting, 
and  can  only  be  carried  a  short  distance.  The  weight  of  the  full 
equipment  of  various  European  countries  ranges  from  57  pounds  in 
France  and  58  in  England,  to  59  in  Germany,  61  in  Austria,  64  in 
Russia  and  70  in  Japan.  The  Japanese  soldier  carries  at  least  one- 
half  his  own  weight  in  winter.  A  notable  diminuation  of  the  weight 

453 


454 


MILITARY    HYGIENE. 


and  bulk  of  the  equipment  could  be  obtained  in  several  countries  by 
making  a  freer  use  of  aluminum. 

The  weight  of  our  own  equipment,  as  shown  further  on,  compares 
favorably  with  that  of  any  other  country. 

It  is  highly  desirable  that  the  equipment  be  divisible  as  in  the 
United  States,  British  and  Japanese  armies,  so  that  when  transpor- 


FIG.  no. —  Improper    and    proper    methods    of    distributing-    the    equipment. 

(Laveran.)     G,  center  of  gravity  of  body  and  load;  g,  center 

of  gravity  of  body. 

tation  is  available  the  men  may  be  relieved  from  part  of  it.     The 
load  of  the  British  soldier  can  thus  be  reduced  to  50  pounds. 

It  is  important,  however,  to  bear  in  mind  that  there  is  a  point 
beyond  which  the  equipment  cannot  be  reduced  without  greatly  im- 
pairing the  efficiency  of  the  soldier.  Troops  in  bivouac,  exposed  to 
cold  and  rain,  without  necessary  food,  clothing  or  covering,  suffer 
much  more  acutely  and  lose  more  of  their  military  efficiency  than 
could  possibly  have  resulted  from  the  addition  of  a  few  more  pounds 
to  their  pack.  It  must  be  admitted  that  the  more  equipment  the 


EQUIPMENT. 


455 


soldier  is  able  to  carry  without  materially  interfering-  with  his  march- 
ing and  fighting  capacity,  the  better  will  his  physical  and  mental 
conditions  be  maintained.  These  considerations  warrant  us  to  state 
that  it  is  much  safer  and  wiser  to  train  the  soldier,  by  vigorous 
marching  exercise,  to  carry  as  much  as  possible  of  his  equipment  on 
the  battlefield,  than  to  depend  upon  baggage  trains  which,  in  all 
probability,  will  fail  to  turn  up  when  most  needed. 


FIG.  ill. —  English  field  equipment. 

Distribution  of  Equipment.  —  The  center  of  gravity  of  the  body  is 
opposite  the  second  lumbar  vertebra  and  2  or  3  inches  in  front  of  it. 
The  line  of  gravity  is  a  vertical  line  passing  through  this  point.  It 
strikes  the  ground  on  a  line  connecting  the  summits  of  the  arches  of 
the  feet  and  midway  between  them.  The  weight  of  the  equipment, 
to  be  properly  balanced,  should  be  as  near  the  line  of  gravity  as 
possible,  and  the  center  of  gravity  of  the  load  and  that  of  the  body 
should  correspond  as  closely  as  practicable.  (Fig.  no.)  This  is 
best  accomplished  by  distributing  the  weight  around  the  body  over 


456 


MILITARY    HYGIENE. 


as  many  points  as  possible ;  such  distribution  has  the  further  advant- 
age to  bring  all  available  muscles  into  play  without  overexerting  any 
special  set.  The  bony  parts  which  practically  bear  the  entire  weight 
are  the  shoulders,  back  and  pelvis  brims.  They  should  all  be  utilized 
to  the  full  extent.  Pressure  over  the  blood-vessels  and  nerves  of 
the  inner  part  of  the  arm,  in  the  axillary  region,  must  be  carefully 


FIG.  112. —  German  field  equipment.     (Lavisse.} 

avoided;  therefore  straps  and  slings  passing  under  the  arm  should 
lie  close  to  the  body  and  run  in  a  direction  more  vertical  than  trans- 
verse. The  free  play  of  the  chest  is  most  important  and  nothing 
should  seriously  interfere  with  it.  It  is  also  obvious  that  nothing 


EQUIPMENT. 


457 


must  impede  the  free  movements  of  the  arms,  especially  in  the  hand- 
ling of  the  rifle. 

Knapsack.  —  The  knapsack  is  an  essential  part  of  the  equipment 
of  all  European  armies;  it  contains  spare  clothing,  toilet  and  per- 


FIG.  113. —  Austrian  field  equipment.     (Lavisse.} 

sonal  articles,  sometimes  cartridges  and  rations.  According  to 
Lavisse,  it  should  be  made  of  hide  covered  with  its  hair,  except  on 
the  inner  face,  which  should  be  of  pliable  leather  to  avoid  heating 
the  back;  this  inner  face  should  be  slightly  concave  and  made  to  fit 
the  back,  thus  bringing  it  nearer  to  the  line  of  gravity ;  to  secure 


458 


MILITARY    HYGIENE. 


this  fit,  2  or  3  sizes  of  knapsacks  should  be  provided,  as  in  the 
German  army.  Lavisse  also  calls  attention  to  the  advantages  of 
giving  sufficient  length  to  the  knapsack,  thus  enlarging  its  capacity, 
causing  it  to  be  supported  by  more  points,  and  removing  the  straps 


FIG.  114.  —  French  field  equipment. 


attached  to  its  lower  end  from  the  axillary  blood-vessels  and  nerves. 
The  French  knapsack  is  particularly  defective  in  this  regard,  as 
shown  in  -Fig.  1  14.  The  contact  of  the  sack  against  the  back  can 
be  softened  by  two  pads  (as  in  the  Swiss  army)  which  have,  besides, 
the  advantage  of  separating  slightly  the  sack  from  the  back,  thus 


EQUIPMENT. 


459 


facilitating  the  circulation  of  air  between  them.  This  separation  is 
also  secured  in  Norway  by  means  of  a  wooden  framework  fitting 
the  back. 

The  knapsack  is  suspended  by  slings  from  the  shoulders  according 
to  various  methods,  and  generally  connected  by  straps  with  the 


FIG.  115. —  Swedish  field  equipment.     (Lavisse.) 

cartridge  boxes  carried  on  the  belt  in  front,  so  as  to  balance  the 
weight. 

Ingenious  and  practical  devices  have  been  recommended  to  sup- 
port part  of  its  weight  upon  the  hips  or  lumbar  region.  Of  them, 
the  Merriam  pack  (first  suggested  by  Dr.  E.  A.  Parkes,  of  Eng- 


460 


MILITARY    HYGIENE. 


land)  is  probably  the  best.  (Fig.  116.)  By  means  of  stiff  wooden 
side  braces,  the  main  part  of  the  soldier's  load  is  transferred  from 
the  shoulders  directly  to  the  large  bones  of  the  hips.  The  advantages 
claimed  for  this  method  are  the  greatly  reduced  pressure  from  the 
shoulders,  entire  freedom  of  motion  of  the  arms  and  unobstructed 
ventilation;  the  abolition  of  every  form  of  cross  belt  so  that  the 
nerves  and  vessels  of  the  armpits  are  wholly  relieved  from  pressure ; 
the  strapping  of  the  blanket,  shelter-half  and  poncho  around  the 
knapsack  out  of  the  way  of  the  rifle ;  the  suppression  of  the  haver- 
sack. 


FIG.  116. —  Merriam  pack. 

In  Europe,  this  principle  of  support  is  only  applied  in  Denmark, 
where  the  knapsack  rests  on  a  strap  lifted  by  a  rod  which  is  secured 
to  the  belt.  Barthelemy,  of  the  French  Army,  has  proposed  the  use 
of  a  cartridge  box,  moulded  to  the  curve  of  the  lumbar  region  and 
firmly  resting  upon  it,  as  a  support  for  the  sack,  a  method  which, 
besides,  brings  the  weight  of  the  latter  much  nearer  the  center  of 
gravity  of  the  body. 


EQUIPMENT. 


461 


U.    S.    ARMY    EQUIPMENT. 

In  our  service  the  knapsack,  never  popular,  was  discarded  in  1908 
and  replaced  by  the  blanket-roll  which,  bent  into  a  horseshoe  shape, 
was  slung  across  the  chest  over  one  or  the  other  shoulder.  (Fig. 
117.)  The  advantages  of  the  roll  were  soon  found  to  be  more  than- 


FIG.  117. —  The  blanket  roll.     Equipment  of  the  U.  S.  foot  soldier,  from  1908 

to  1910. 


462  MILITARY    HYGIENE. 

counterbalanced  by  its  defects.     It  heats  the  neck  and  chest  to  an 
uncomfortable  degree,   restrains   the   expansion   of  the  lungs  and 
interferes  with  the  free  use  of  the  arms  and  handling  of  the  rifle. 
In  1910,  it  was  replaced  by  the  present  equipment,  which  was  con- 
structed on  entirely  new  and  original  lines. 
Three  forms  of  it  are  used: 
The  full  equipment  (Fig.  118), 
The  marching  equipment, 
The  fighting  equipment. 
The  full  equipment  consists  of : 
Identification  tag, 
Rifle  and  sling, 
Bayonet  and  scabbard, 
Cartridge  belt, 
Ammunition  (100  rounds), 
Intrenching  tool  and  carrier  (6  tools  carried  by  every  squad: 

3  shovels,  i  pick,  i  hand  ax  and  I  wire  cutter). 
First-aid  packet  and  pouch, 
Canteen,  cup  and  cover,  .  . 

Haversack,  containing: 

Mess-kit  (meat-can,  fork,  spoon  and  knife). 
Rations  (2  reserve  rations  or  i  reserve  and  i  emergency), 
Socks,  one  pair, 

Toilet  articles  (towel,  comb,  tooth-brush,  soap), 
Pack,  consisting  of  carrier,  blanket,  poncho  or  slicker,  clothing, 

shelter-tent  half,  pole  and  pins. 

The  marching   equipment   is   the   same   as   the    full   equipment, 

minus  the  pack  which  is  normally  carried  in  the  company  wagon. 

The  fighting  equipment  is  the  same  as  the  marching  equipment 

with  the  addition  of  two  bandoleers  of  60  rounds  each,  thus  giving 

the  soldier  220  rounds  of  cartridges. 

The  weight  of  the  full  equipment  is  40  Ibs.  5  oz. ;  of  the  march- 
ing equipment  31  Ibs.  4  oz.,  and  of  the  fighting  equipment  39  Ibs.  i  oz. 
To  this  should  be  added  the  weight  of  the  clothing  carried  on  the 
person  (exclusive  of  coat,  sweater  and  overcoat),  namely  7  Ibs. 
ii  oz.  This  clothing,  for  infantry  in  the  field,  consists  of:  service 
hat,  neckerchief,  olive-drab  shirt,  olive-drab  breeches,  undershirt, 
drawers,  woolen  socks,  shoes,  leggins,  waist  belt  (optional), 
gauntlets  (only  when  mounted). 


EQUIPMENT. 


463 


Thus  it  appears  that  the  weight  of  the  marching  equipment,  plus 
the  ordinary  clothing  worn,  is  38  Ibs.  15  oz.  When  weather  condi- 
tions require  it,  the  sweater  is  worn  over  the  shirt,  and  the  weight 


G.  118. —  Full  equipment,  U.  S.  Infantry. 
The  puttees  should  be  replaced  by  leggins. 


464 


MILITARY    HYGIENE. 


FIG.  119. —  The  haversack  and  pack-carrier,  assembled  and  spread  out. 


EQUIPMENT.  465 

(about  2  Ibs.)  must  be  added,  making  a  total  of  40  Ibs.  and  15  oz. 
If  overcoats  and  sweaters  are  not  needed  they  are  packed  in  boxes 
and  left  at  the  nearest  convenient  depot.  If  the  overcoat  is  worn, 
the  weight  (9  Ibs.)  must  be  added,  making  a  total  of  49  Ibs.  15  oz. 
It  is  doubtful  whether  this  weight  can  be  reduced  (except  possibly 
in  the  overcoat)  without  sacrificing  something  of  strength  and 
durability. 

The  "  field  kit "  which  is  carried  on  the  person  by  dismounted 
and  on  the  saddle  by  mounted  men,  is  supplemented  by  the  "  sur- 
plus kit,"  carried  in  the  train,  the  two  together  making  up  the  cloth- 
ing component  of  the  service  kit. 

The  field  kit  clothing  component,  in  addition  to  the  qlothing 
worn  on  the  person,  is  composed  of  the  following  articles : 

I  blanket;  I  poncho  or  slicker;  i  drawers,  pair;  I  undershirt; 
2  stockings,  pairs;  i  towel;  i  housewife  (for  one  man  of 
each  squad). 

The  surplus  kit  consists  of : 

i  breeches,  pair;  i  drawers,  pair;  i  shirt,  olive  drab;  I  shoes, 
russet  leather,  pair;  2  stockings,  pair;  one  shoe  laces,  extra, 
pair;  i  undershirt. 

The  haversack  and  pack-carrier  are  made  of  olive-drab  cotton 
duck,  bound  with  olive-drab  cotton  webbing  (Fig.  119).  The 
haversack  consists  essentially  of  body,  meat-can  pouch,  flaps  and 
suspenders  (Fig.  120).  By  means  of  the  inside  flap,  the  body  can 
be  converted  into  a  bag  of  varying  dimensions  capable  of  carrying 
anything  up  to  4  days'  rations.  It  holds  two  small  tin  cans,  one 
for  bacon,  the  other  for  sugar,  coffee  and  salt  (see  reserve  ration}. 
It  can  be  washed  and  scrubbed  when  necessary.  The  meat-can 
consists  of  body  (or  dish)  and  cover  (or  plate),  both  of.  alumi- 
num (Fig.  121 ).  To  the  body  is  attached  a  steel  handle  (alumi- 
nized)  by  a  hinge  of  German  silver,  so  that  it  can  be  used  to 
cook  food  on  the  fire.  The  cover  fits  accurately  over  the  body 
and  is  held  firmly  in  place  by  the  handle  folded  over  it  and  caught 
in  the  rim  of  the  body.  The  knife,  fork  and  spoon  are  carried 
in  the  meat-can. 

The  haversack  and  pack  are  fastened  together  by  a  coupling 
strap,  forming  a  compact  and  roughly  cylindrical  bundle,  6-8  inches 
in  diameter  and,  when  in  position,  extending  from  the  level  of  the 


466 


MILITARY    HYGIENE. 


FIG.   120. —  Haversack,  spread  out, 
the  carrier  detached. 


EQUIPMENT. 


467 


shoulders  to  a  point  3-5  inches  below  the  waist  line  (Fig.  118). 
It  is  held  in  a  vertical  position  on  the  back  by  means  of  wide  sus- 
penders attached  to  the  top  of  the  haversack,  carried  over  the 
shoulders,  beneath  the  arms  and  secured  to  the  pack  carrier  near 
the  bottom  of  the  bundle.  A  branch  is  given  off  from  each  suspender 
and  attached  to  the  belt  in  front,  thus  utilizing  the  weight  of  the 
ammunition  to  balance  the  load  on  the  back  and  bring  its  center 
of  gravity  as  near  as  possible  to  that  of  the  body.  A  short  back 
suspender  hangs  from  the  haversack  and  is  fastened  to  the  belt  in 
rear  to  further  steady  the  load  and  serve  as  third  point  of  support 
for  the  loosely  worn  cartridge  belt. 

At  halts,  during  the  march,  the  bearer  can  quickly  remove  or 
replace  the  bundle,  or  if  he  sits  down  without  removing  it,  the 
bottom  rests  upon  the  ground,  instantly  releasing  the  pressure  and 
weight  from  the  body. 


FIG.  121. —  Meat-can,     i,  Body  with  handle;  2,  cover;  3,  meat-can  closed. 

By  withdrawing  the  coupling  strap,  the  pack  is  separated  from 
the  haversack,  in  compact  shape  easily  transportable  and  identified, 
while  the  haversack  remains  in  position. 

This  equipment,  as  a  whole,,  fulfills  all  necessary  desiderata.  The 
bundle  is  in  its  proper  place  anatomically,  supported  by  the 
shoulders  and  spine.  Its  cylindrical  shape  presents  a  minimum 
surface  of  contact  with  the  back,  interfering  but  slightly  with 
ventilation.  Its  center  of  gravity,  in  connection  with  the  cartridge 


468  MILITARY    HYGIENE. 

belt,  is  brought  reasonably  near  that  of  the  body.  It  hangs  com- 
fortably, with  but  little  pressure  or  constriction  of  muscles,  blood- 
vessels and  nerves.  It  places  no  restriction  upon  the  full  expansion 
of  the  chest  and  free  play  of  lungs  and  heart,  there  being  no  strap 
of  any  kind  between  the  suspenders  in  front;  nor  is  there  any 
interference  with  the  full  use  of  arms  and  legs  or  the  free  handling 
of  the  rifle  from  any  position.  It  might  be  objected  that  the 
suspenders,  as  they  pass  under  the  arms,  are  liable  to  compress  the 
axillary  vessels  and  nerves,  but  inasmuch  as  their  direction  is 
obliquely  downward  and  inward,  such  compression  can  seldom  have 
any  injurious  effect. 

The  pack,  as  already  stated,  consists  of  a  detachable  carrier  con- 
taining the  blanket,  poncho  and  shelter-tent  half. 

Only  one  type  of  blanket  is  issued ;  it  is  an  olive-drab  woolen 
blanket  7  feet  long  and  $l/2  feet  wide,  with  tapes  along  the  sides 
and  bottom,  weighing  3  pounds.  It  has  been  ascertained  that,  with 
the  sweater  and  poncho  to  supplement  it,  this  blanket  will  afford 
ample  protection  against  the  ordinary  weather  of  temperate  zones. 
For  winter,  or  service  in  cold  climates,  a  second  or  even  a  third 
blanket  may  be  issued. 

The  poncho,  for  the  use  of  foot  troops  (Fig.  122),  is  made  of 
waterproof  cotton  sheeting,  to  weigh  no  less  than  2  pounds  10 
ounces,  nor  more  than  3  pounds.  It  consists  of  body,  fly  and 
extension.  It  is  75  inches  long,  exclusive  of  extension,  and  59 
inches  wide  exclusive  of  fly,  and  is  passed  over  the  head  by  a  cross- 
wise opening  13  inches  long  in  center  seam.  The  slicker,  for  the 
use  of  mounted  troops,  is  made  of  the  same  material,  and  so  shaped 
as  to  protect  not  only  the  rider  but  also  his  saddle  equipment. 

The  poncho  and  blanket  are  of  suitable  size  and  shape  to  form  a 
comfortable  sleeping  bag,  the  blanket  being  folded  and  tied  together 
by  means  of  its  tapes,  and  the  poncho  buttoned  together  over  the 
blanket.  A  double  sleeping  bag  can  also  be  made  by  means  of  two 
ponchos  with  two  blankets  between,  the  latter  being  tied  together 
along  the  edges  and  the  foot  end. 

Cartridge  belt. —  (Fig.  123).  This  is  a  woven  webbing  belt,  3 
inches  wide,  consisting  of  two  pocket  sections,  right  and  left,  con- 
nected by  an  adjustment  strap  at  the  back,  2  inches  wide.  Each 
section  has  5  pockets  of  the  required  size  for  holding  two  clips  of 
five  cartridges,  each  pocket  with  flap  secured  by  a  glove  fastener. 


EQUIPMENT. 


469 


In  the  belt  for  mounted  men,  the  front  pocket,  on  each  side  of  the 
fastener,  is  replaced  by  two  smaller  pockets,  one  above  the  other, 
and  of  suitable  size  for  holding  five  revolver  cartridges.  Thus  it  is 
seen  that  the  ammunition  is  always  in  front,  and  the  adjustment 
entirely  in  rear.  The  belt  is  adjusted  so  as  to  fit  loosely  about  the 


FIG.   1 22,-r- Poncho,  for  U.  S.  Infantry. 


470 


MILITARY    HYGIENE. 


waist  and  rest  well  down  over  the  hip  bones,  and  below  the  pit  of 
the  abdomen  in  front.  It  is  held  up  by  three  suspenders  from  the 
haversack,  one  in  rear  and  two  in  front,  all  hooked  into  correspond- 
ing eyelets  in  the  upper  edge.  Therefore  it  is  supported,  as  it 
should  be,  from  the  shoulders  and  by  the  hips.  It  also  balances 
the  weight  of  the  bundle  on  the  back  and  tends  to  bring  the  center 
of  gravity  of  the  equipment  towards  the  front.  To  the  belt,  on 
the  right  side,  are  suspended  the  first-aid  pouch  and  the  canteen 
cover  by  double-hook  attachments  in  the  eyelets  between  the 
pockets,  on  the  lower  edge,  the  former  under  the  second  pocket 
and  the  latter  under  the  rear  pocket. 


FIG.  123. —  Cartridge  belts,  for  infantry  and  cavalry. 

Canteen  and  cup.  —  The  canteen  is  flask-shaped  with  a  flat  bottom, 
slightly  concave  on  the  side  next  to  the  body,  and  is  nested  in  the 
cup  for  transportation.  The  body  is  of  one  piece  of  seamless 
aluminum  and  has  a  capacity  of  two  pints.  The  neck  is  threaded 
to  receive  the  aluminum  screw  cap  which  is  held  by  chain  and 
sliding  ring  also  of  aluminum.  The  canteen  cover  is  of  olive-drab 
cotton  duck,  lined  with  gray  felt,  both  materials  stitched  together; 
the  top  of  that  portion  forming  the  back  terminates  in  two  flaps 
which,  with  the  canteen  and  cup  in  position,  fold  over  and  are 
secured  to  the  front  part  by  glove  fasteners.  A  double-hook  attach- 


EQUIPMENT.  471 

ment  is  stitched  to  the  back  for  suspension  to  the  belt  under  the 
rear  pocket  on  the  right.  The  canteen  can  be  readily  withdrawn 
from  its  cover  in  order  to  heat  or  sterilize  its  contents,  and  as 
readily  replaced. 

The  cup  is  of  one-piece  seamless  aluminum  drawn  and  shaped 
to  correspond  to  the  lower  half  of  the  canteen.  The  folding  handle, 
when  open  and  fixed  in  position  makes  an  additional  support  for 
the  cup  when  placed  on  the  ground.  When  the  cup  is  not  in  use 
the  handle  is  sprung  over  the  cup  body. 

The  aluminum  canteen  has  been  objected  to  on  the  ground  that 
it  imparts  a  metallic  taste  to  tea  and  coffee  kept  in  it;  but  this  is 
due  to  the  metals  with  which  aluminum  is  alloyed,  principally  iron 
and  copper.  Pure  aluminum,  or  aluminum  alloyed  with  magnesium 
is  not  open  to  this  objection. 

The  pouch  for  first-aid  packet  is  of  olive-drab  cotton  duck,  with 
flap  secured  by  two  glove  fasteners,  and  a  double-hook  attachment 
for  suspension  to  the  lower  edge  of  the  belt  under  the  second  pocket 

on  the  right. 

CAVALRY   EQUIPMENT. 

In  the  cavalry,  the  equipment  is  distributed  on  the  saddle  as  shown 
in  Fig.  124  (Model  of  1912),  the  trooper  carrying  only  the  cart- 
ridge belt  and  bandoleer  on  his  person.  The  cantle  roll  is  formed 
of  the  shelter  tent  containing  tent  pins,  underclothing  and  toilet 
articles.  It  is  about  30  inches  long,  its  ends  resting  on  top  of  the 
ration  bags.  The  ration  bags  will  carry,  together,  two  reserve 
rations  and  one  emergency  ration.  They  are  so  constructed  as  to 
permit  of  their  being  assembled  into  a  haversack  for  use  on  dis- 
mounted duty ;  it  is  carried  on  the  trooper's  back  and  secured  by 
suspenders  and  belt.  When  on  such  duty,  a  roll  about  42  inches 
long,  consisting  of  saddle  blanket,  or  shelter  tent,  containing  neces- 
sary clothing  and  toilet  articles  is  placed  symmetrically  on  top  of 
the  knapsack,  the  ends  bent  down,  and  secured  to  the  top  and  sides 
of  the  knapsack  by  the  thongs  provided  for  this  purpose. 

MEDICAL    DEPARTMENT    EQUIPMENT. 

The  Medical  Department  has  recently  discarded  the  large,  un- 
wieldy pouch  carried  by  the  members  of  the  Hospital  Corps,  and 
replaced  it  by  a  belt  carrying  10  even-sized  pockets.  From  this 
belt  depend  an  instrument  case,  the  canteen  and  a  hand  axe  (which 


4/2 


MILITARY    HYGIENE. 


(TCD  BAG  AND  GRAIN  BAG. 

RAIN  COAT  CR  (NERCOATV 

POMMEL  POCKET. 


CARTRIDGE 
9ELT  RING. 
STOCK  COVER. 


BER  SCABBARD. 
CARRIER  STRAP. 


TENT. 
7ATION  BAG. 

?IFLE  CARRIER  BOOT. 


takes  the  place  of  the  Hospital  Corps  knife).  The  articles  in  the 
belt  are  distributed  uniformly  around  the  waist  line  and  so  placed 
that  they  are  all  easy  of  access. 

The  Medical  Department  has  also  adopted  so  much  of  the  new 
model  cavalry  equipment  as  is  suitable  for  the  use  of  Hospital 
Corps  men.  This  equipment,  as  noted  above,  is  so  constructed  as 
to  be  readily  adaptable  to  either  mounted  or  dismounted  service,  a 
feature  especially  desirable  for  the  Hospital  Corps. 


CHAPTER   XXXVIII. 
POSTS,  BARRACKS  AND  QUARTERS. 

The  site  for  a  military  post  should  be  selected  with  the  greatest 
care,  so  as  to  meet  not  only  military  but  also  economic  and  hygienic 
requirements.  A  post  should  be  a  model  and  an  object-lesson  to  the 
surrounding  region  in  regard  to  the  most  approved  methods  of 
caring  for  a  large  aggregation  of  men.  Therefore  no  selection  of 
site  should  be  made  and  no  plans  decided  upon  without  consulting  a 
competent  medical  officer.  Ample  grounds  are  necessary  to  prevent 
crowding  of  buildings  and  have  plenty  of  space  for  formations  and 
drills.  For  this  reason  it  will  seldom  be  possible  to  establish  a  post 
in  or  very  near  a  city ;  such  location  would,  besides,  be  open  to  other 
objections:  the  noise,  smoke  and  dust  of  railroads  and  factories,  the 
allurements  of  dissipation  and  the  danger  of  contracting  infectious 
diseases.  It  is  best,  therefore,  that  a  post  should  be  well  outside 
of  a  town,  where  a  sufficiently  large  reservation  can  be  secured, 
but  yet  not  so  far  as  to  remove  it  from  the  many  conveniences  and 
advantages  which  such  neighborhood  offers.  Not  only  does  the 
vicinity  of  a  town  afford  to  officers  and  men  facilities  for  general 
information  tending  to  their  greater  efficiency,  but  it  is  also  in  the 
interest  of  the  country  that  the  civilian  should  become  familiar  with 
the  military  uniform. 

From  the  hygienic  point  of  view,  the  site  of  a  post  should  be  high 
and  dry,  away  from  marshes,  neither  on  a  wind-swept  summit  nor 
in  a  contracted  valley  where  surface  waters  collect,  but  rather  on 
gently  sloping  grounds  with  good  natural  drainage,  not  liable  to 
contamination  from  any  neighboring  town,  and  with  sandy  or 
gravelly,  porous  soil.  The  ground-water  should  not  be  less  than 
8  or  10  feet  deep.  Should  it  be  necessary  to  occupy  a  low  site, 
with  ground-water  within  a  few  feet  of  the  surface,  thorough  under- 
ground drainage  would  be  necessary,  for  there  is  no  medical  doctrine 
better  established  than  that  of  the  detrimental  effects  of  constant 
humidity  upon  health.  The  question  of  water-supply  will  require 
careful  consideration.  As  there  are  now  few  places  in  the  inhabited 
parts  of  the  United  States  and  our  colonies  where  good  drinking 
water  in  sufficient  quantity  can  be  obtained  from  uncontaminated 

473 


474  MILITARY    HYGIENE. 

streams  or  lakes,  it  will  generally  be  necessary  to  provide  a  purifica- 
tion plant,  or  else  connect  the  post  with  the  system  of  a  town  having 
such  a  plant. 

The  buildings  of  a  post  must  be  so  constructed  and  exposed  as  to 
get  as  much  air  and  sunlight  as  possible ;  hence  the  rule  that  the 
interval  between  them  will  be  at  least  equal  to  one  and  a  half  times 
their  height.  In  cold  and  temperate  climates  they  should  face  east 
and  west  so  that  they  may  receive  the  full  benefit  of  the  warm 
afternoon  sun,  while  in  warm  countries  they  should  face  south  and 
north;  but  this  question  of  exposure  will  necessarily  be  influenced 
by  the  direction  of  prevailing  winds,  local  conditions  and  architectural 
exigencies  (Fig.  125). 

The  size,  shape  and  internal  arrangements  of  barracks  have  been 
quite  variable  and,  until  recently,  with  but  little  regard  to  hygienic 
requirements.  In  Europe,  where  economy  of  space  imposes  itself, 
they  are  mostly  large,  several-storied,  monumental  structures,  each 
accommodating  a  battalion  or  even  a  regiment ;  they  generally  suffer 
from  serious  hygienic  defects  and  have  often  been  unduly  crowded, 
with  consequent  higher  mortality.  During  the  last  thirty  years  a 
strong  reaction  has  manifested  itself  in  favor  of  smaller  barracks, 
especially  of  separate  i-story  pavilions,  and  the  health  of  troops  has 
much  improved  in  consequence.  In  France,  for  instance,  the  Toilet 
pavilion  has  been  introduced  in  several  garrison  towns.  It  is  a 
simple  structure  of  brick  and  iron,  27  feet  wide  and  25  high,  un- 
ceiled,  with  ogival  roof,  and  ventilated  through  the  ridge.  Its  claims 
are :  that  it  separates  men  and  organizations  and  reduces  the  chances 
of  communicating  disease,  diminishes  as  much  as  possible  all  in- 
fectible  and  putrescible  material,  renders  all  surfaces  impervious  to 
germs  and  vermin,  suppresses  angles  and  furnishes  a  maximum  of 
enclosed  air  with  a  minimum  of  enclosing  surface,  favors  natural 
ventilation,  and  relegates  all  services  likely  to  compromise  health 
(kitchens,  laundries,  latrines,  etc.)  to  outside  places.  It  has  become 
obvious,  however,  that  such  a  system  demands  too  large  areas  and 
scatters  the  command  to  an  inconvenient  extent.  It  has  been  given 
up  in  Europe,  where  the  present  tendency  is  to  return  to  the  prin- 
ciple of  moderate  concentration.  Experience  has  demonstrated  that 
in  temperate  as  well  as  in  tropical  climates,  barracks  of  two  stories 
are  fully  as  hygienic  as  i-story  pavilions,  besides  being  less  expen- 
sive of  space  and  money,  and  more  easily  administered. 


POSTS,    BARRACKS    AND    QUARTERS.  475 

Each  company,  troop  or  battery  should  preferably  have  its  own 
separate  barrack,  kitchen  and  mess.  In  order  that  they  may  receive 
as  much  light  and  air  as  possible,  barracks  should  be  parallel  to  one 
another  and,  if  the  terrain  permits,  in  echelon  ;  that  is  to  say,  each  one 
projecting  more  or  less  beyond  the  last.  The  disposition  in  squares 
or  quadrangles  is  very  objectionable,,  as  one  or  more  sides,  as  well 
as  the  enclosed  court,  will  be  shut  off  from  the  sunlight  and  prevail- 
ing breezes ;  were  such  an  arrangement  rendered  imperative  by  local 
conditions,  a  wide  interval  between  adjoining  buildings  should  be 
left  at  the  four  corners. 

In  England,  according  to  Melville,  the  latest  plans  show  a  dis- 
position to  concentrate  an  entire  battalion  in  a  block  of  one  or  two 
buildings.  Thus  the  Windsor  Barracks,  recently  erected  to  accom- 
modate 5  companies,  consist  of  two  parallel  buildings,  two  and 
three-story  high,  separated  by  an  open  space  of  75  feet  covered  by 
a  flat  roof  with  large  ventilating  lantern  lights.  The  greater  part 
of  this  space  is  used  for  mess-rooms. 

A  striking  innovation  in  these  barracks  is  the  introduction  of  the 
individual  cubicle  system,  the  cubicles  or  cells  opening  on  each  side 
of  a  long  corridor,  with  partition  walls  7  feet  5  inches  high,  leaving 
a  space  of  2  feet  7  inches  above  to  the  ceiling,  as  well  as  a  space 
6  inches  below  to  the  floor.  Each  cell  is  7  feet  6  inches  long  and  6 
feet  wide,  and  has  its  own  window,  2  feet  6  inches  broad,  the  upper 
half  of  which  is  a  fanlight,  opening  inward  and  controlled  by  a 
screw  rod  operated  from  the  N.  C.  O.'s  room.  Large  recreation 
rooms  are  provided,  so  that  there  is  seldom  occasion  for  the  men  to 
go  to  their  cubicles  during  the  day  except  collectively,  before  and 
after  formations.  The  floor  space  of  the  cubicle  (45  square  feet), 
although  comparing  favorably  with  that  of  most  European  barracks, 
is  certainly  smaller  than  that  deemed  necessary  by  all  hygienists. 
The  window  in  each  cubicle,  however,  must  be  taken  into  considera- 
tion as  a  means  of  ventilation. 

The  above  system  is  excellent  in  principle.  There  is  no  reason 
why  soldiers  should  not  be  given  a  reasonable  degree  of  privacy  in 
dormitories,  so  as  to  foster  a  sense  of  self-respect  and  decency.  A 
room  to  each  man,  however,  is  hardly  to  be  commended,  for  such 
arrangement  seriously  interferes  with  supervision,  ventilation  and 
cleanliness.  A  desirable  compromise  would  be  to  divide  the  dormi- 
tory into  squad-rooms,  each  for  a  squad  of  8  men,  including  the 
N.  C.  O.  in  charge  of  it,  and  with  partitions  open  above  and  below. 


476 


MILITARY    HYGIENE. 


ETHAN  ALLEN 
VERMONT. 


FIG.  125.—  Fort  Ethan  Allen,  Vermont.  Post  of  modern  construction, 
showing  arrangement  of  buildings,  i,  Commanding  officer's  quarters-  2 
officers  quarters;  3  guard  house;  4,  barracks;  5,  band  quarters;  6,  saddler 
shops ;  7,  hospital ;  8,  non-commissioned  staff  quarters ;  9,  cavalry  drill-hall  • 
10,  cavalry  stables;  11,  post  exchange;  12,  bakery;  13,  store-house;  14,  store- 
house; 15,  scale-house;  16,  forage-house;  17,  shops;  18,  ordnance;  19  fuel- 
shed;  20,  oil-house;  21,  magazine;  22,  water  tower.  (From  Mimson  )' 


POSTS,    BARRACKS    AND    QUARTERS.  477 

Construction  and  Materials.  —  The  property  of  building  materials 
which  most  concerns  the  hygienist  is  porosity,  that  is  to  say,  the 
amount  of  air  they  contain.  From  this  depend  their  heat  con- 
ductivity, moisture  capacity,  air  and  water  permeability.  Since  air 
is  a  worse  conductor  than  any  liquid  or  solid  substance,  the  more 
porous  a  material  the  lower  is  its  heat  conductivity  and  capacity ; 
in  other  words,  the  more  easily  are  its  surfaces  warmed,  but  the  more 
slowly  does  heat  penetrate  through  it.  Walls  of  such  material  will 
absorb  but  little  sunheat  and  lose  but  little  of  the  inside  artificial 
heat,  therefore  will  keep  a  building  cool  in  summer  and  warm  in 
winter.  Another  property  they  possess  is  bad  conductivity  to  sounds. 

The  above  qualities  of  porous  materials  are  necessarily  modified 
by  moisture,  according  to  the  quantity  of  air  which  is  replaced  by 
water;  they  become  better  heat  conductors  and  lose  more  or  less  of 
their  permeability ;  the  larger  the  pores  the  less  is  the  increase  of 
conductivity  and  loss  of  permeability,  and  the  quicker  do  they  dry 
after  a  rain. 

The  permeability  to  air  of  building  materials  has  sometimes  been 
considered  a  valuable  factor  in  the  ventilation  of  buildings.  But  the 
researches  of  Lang  and  Recknagel  have  demonstrated  that  the 
amount  of  air  capable  of  passing  through  the  most  porous  of  them 
is  practically  insignificant  and  a  negligible  quantity  with  regard 
to  the  renewal  of  air  and  ventilation  of  rooms,  especially  when  the 
walls  are  plastered,  painted,  or  paper-covered. 

Bricks  are  light,  cheap,  durable  and  porous,  and,  for  these  quali- 
ties, very  generally  used.  Their  marked  porosity  makes  them  a  bad 
heat  conductor.  Thus  a  brick  wall  10.  inches  thick  will  protect  as 
efficiently  against  external  variation  of  temperature,  in  a  moderate 
climate,  as  one  of  limestone  20  inches  thick  (Arnoitld}.  It  must  be 
borne  in  mind,  however,  that  to  prevent  the  transmission  of  solar 
heat  into  a  building,  a  wall,  of  whatever  material,  must  have  suffi- 
cient thickness;  thus,  a  brick  wall  only  12  to  15  inches  thick  may 
become  so  heated  in  the  day  that  it  only  partially  cools  off  at  night, 
and  its  temperature  will  continue  to  rise  from  day  to  day  until  its 
internal  surface  is  reached.  The  use  of  perforated  brick  in  walls, 
at  least  for  the  inside  course,  adds  very  much  to  their  non-conduc- 
tivity and  is  therefore  highly  desirable  in  all  climates.  In  tropical 
countries,  it  is  a  further  advantage  to  build  double  walls  with  an 
air  space  of  2  to  4  inches  between  them ;  this  space  should  be  pro- 
vided with  screened  outlets  for  the  free  escape  and  renewal  of  air. 


4/8  MILITARY    HYGIENE. 

The  porosity  of  brick  renders  them  quite  permeable  to  air,  espe- 
cially under  the  pressure  of  a  strong  wind.  They  are  also  very 
absorbent,  taking  up  10  to  20  per  cent,  of  their  volume  of  water. 
For  these  reasons,  brick  walls  should  always  be  plastered,  at  least 
inside,  and  unless  otherwise  protected  from  rain  it  is  often  advisable 
to  paint  them  outside;  nor  should  they  ever  be  in  direct  contact 
with  the  soil. 

Stone,  especially  marble,  hard  sandstone,  granite,  etc.,  is  less 
porous  than  brick  and  a  better  conductor  of  heat ;  it  absorbs  less 
water  but  retains  it  longer;  on  the  other  hand,  it  is  more  durable 
and  sightly. 

Wood  is  a  very  poor  conductor  of  heat  and  affords  efficient  pro- 
tection against  the  sun,  but  is  very  hygroscopic,  moisture  causing 
it  to  expand  irregularly,  with  disjunction  of  parts,  cracks  and  fissures 
leading  to  decay  and  favoring  the  collection  of  dirt  and  parasites. 
It  is,  besides,  always  in  danger  of  fire. 

Iron,  now  so  largely  used  for  the  framework  of  buildings,  is  an 
excellent  conductor  of  heat  and  sound ;  but  this  defect  is  mitigated 
by  a  sufficient  covering  of  stone  or  brick  and  mortar.  It  has  the 
advantage  of  being  impenetrable  to  humidity. 

Ordinary  mortar,  consisting  of  lime,  sand  and  water,  is  very 
porous,  especially  when  made  with  coarse  sand.  Plaster  is  still  a 
poorer  conductor  of  heat  than  mortar,  although  less  permeable ;  it 
is  the  most  hygroscopic  of  materials.  Cement  and  concrete  are 
waterproof  and  have  little  porosity  and  permeability,  therefore  are 
good  conductors  of  heat. 

A  new  building  contains  a  large  proportion  of  water,  from  130 
to  230  liters  in  a  cubic  meter  of  brick  masonry,  according  to  Flugge.. 
Such  excessive  humidity  must  be  gotten  rid  of  before  it  is  habitable. 

In  a  damp  building  the  cutaneous  evaporation  is  checked,  while  the 
loss  of  body  heat  by  radiation  and  conduction  is  increased ;  it  follows 
that  the  occupants  are  unduly  overheated  when  the  temperature  rises, 
and  chilled  when  it  falls.  Furthermore,  damp  walls  being  better 
heat  conductors,  the  building  is  difficult  to  warm  in  cold  weather, 
or  becomes  overheated  by  the  sun  in  hot  weather.  For  these  rea- 
sons, confined  dampness  has  an  unfavorable  influence  upon  human 
health,  leading  to  catarrhal  and  rheumatic  affections  as  well  as  to 
tuberculosis.  No  plastering  or  coating  of  any  kind  should  be  put 


POSTS,    BARRACKS    AXD    QUARTERS. 


479 


on  the  walls  until  they  are  quite  dry,  that  is,  until  the  mortar, 
which  in  the  fresh  state  contains  15  per  cent,  of  free  water,  has 
dried  down  to  2  per  cent,  or  less.  Plaster  contains  nearly  twice  as 
much  water  as  mortar  and  dries  very  slowly.  It  is  readily  seen, 
therefore,  why  a  newly  completed  house  should  be  thoroughly 
ventilated  and  gradually  heated,  at  least  for  a  week  or  two,  accord- 
ing to  the  weather,  before  it  is  fit  for  occupancy. 

CELLARS  AND  BASEMENTS.  —  Cellars  and  basements  improve  the 
healthfulness  of  buildings,  provided  they  are  properly  constructed. 
Unless  they  are  impervious  to  ground-air  and  water  they  do  more 


FIG.  126.  —  Method  of  flooring  cellars 
to  prevent  dampness,  a,  Disconnected 
air-space  lined  with  cement;  b,  cement; 
c,  concrete;  d,  clay.  (Mitnson.) 


FIG.  127. —  Method  of  prevent- 
ing  dampness  of  walls.  Letters 
DC  denote  location  of  damp- 
proof  courses.  (Munson.) 


harm  than  good.  Ground-water  may  rise  into  them  or  keep  the 
floor  and  walls  constantly  damp;  ground-air,  more  or  less  polluted, 
readily  escapes  into  them  and,  as  it  becomes  warm,  ascends  into  the 
building  carrying  more  or  less  humidity  with  it.  Even  under  the 
best  conditions,  air  moisture  readily  condenses  on  the  cool  walls  of 
a  cellar,  and  unless  well  ventilated  or  artificially  heated  it  will 
seldom  be  perfectly  dry.  It  is  necessary  therefore  that  cellars  and 
all  other  substructures  should  be  made  impervious.  Damp  grounds 
must  be  underdrained.  The  floor  should  be  covered  with  a  layer 
of  concrete  coated  over  with  cement  or  asphaltum.  A  more  perfect 


480  MILITARY    HYGIENE. 

result  is  attained  by  placing  the  concrete  over  a  stratum  of  well- 
tamped  clay. 

FOUNDATIONS.  —  The  best  material  for  foundations  is  stone. 
Their  most  important  hygienic  requirement  is  that  they  be  water- 
proof. Therefore,  besides  being  drained,  they  should  rest  on  a  bed 
of  impervious  concrete  (concrete  footing)  and  be  protected  from 
outside  moisture  by  layers  of  tar  and  cement  (Fig.  126),  or  by  a 
trench  extending  down  to  the  footing  and  filled  with  broken  stone. 
A  double  foundation  wall,  with  air  space  of  2  or  3  inches,  is  also 
very  useful  in  preventing  much  of  the  outside  moisture  from  reach- 
ing the  internal  surface  (Fig.  127).  The  space  may  be  loosely 
filled  with  a  non-hygroscopic  material,  such  as  cinders.  In  order 
to  preclude  the  rising  of  moisture  into  the  walls  by  capillary  attrac- 
tion, it  is  also  necessary  to  interpose,  at  the  level  of  the  soil,  a 
"  damp-proof  course,"  consisting  of  slates,  vitrified  bricks  or  water- 
proof felt  imbedded  in  cement  or  asphaltum. 

Barracks  and  other  buildings  without  basement  or  cellar  should  be 
raised  above  the  ground,  leaving  a  clear  air  space  beneath,  large 
enough,  if  possible,  for  inspection  and  cleaning.  A  further  improve- 
ment would  consist  in  cementing  the  floor  of  this  space. 

PLASTERING.  —  Walls  may  be  furred,  lathed  and  plastered,  with 
an  air  space  of  about  two  inches  between  the  brick  and  lathing,  ma- 
terially contributing  to  their  dryness  and  non-conductivity.  The  use 
of  perforated  brick  for  the  inside  course  renders  lathing  unneces- 
sary ;  such  brick  furnish  a  sufficient  air  space  and  are  of  equal 
hygienic  value,  without  providing  a  harbor  for  rodents  and  vermin. 
The  use  of  metallic  woven-wire  lathing,  now  becoming  general,  is 
likewise  entirely  satisfactory.  Plaster  may  also  be  applied  upon  a 
wall  of  solid  brick  by  the  intervention  of  a  thin  coating  of  adhesive 
material,  but  this  is  clearly  undesirable. 

Partition  walls  should  preferably  consist  of  large  hollow  tile,  of 
light,  incombustible  material,  non-conductor  of  heat  and  sound ;  such 
walls  are  readily  plastered  without  the  intervention  of  any  other 
material. 

Ordinary  plaster  is  porous  and  absorbent,  and  therefore  a  poor 
material  for  the  inner  finishing  of  the  walls  of  barracks  or  any  build- 
ing occupied  by  a  number  of  men.  The  vapor  of  respiration  con- 
denses upon  it  and  all  the  impurities  floating  in  the  air  readily 
adhere  to  it.  It  should  be  whitewashed  or  kalsomined  at  least  once 


POSTS,    BARRACKS    AND    QUARTERS.  481 

a  year.  Water  paints,  however,  are  always  unsatisfactory.  They 
are  not  durable  and  soon  scale,  nor  can  they  be  washed  down  and 
disinfected,  while  the  binding  material  (glue,  dextrin,  casein,  etc.) 
is  liable  to  develop  musty  and  foul  odors.  Much  preferable  is  the 
use  of  a  harder,  less  porous  material,  one  that  can  be  readily  washed, 
such  as  adamant  plaster,  soapstone  finish,  good  oil  or  enamel  paint, 
etc.  Where  a  certain  degree  of  ornamentation,  together  with  more 
complete  asepsis  are  desired,  as  in  bath-rooms,  operating  rooms,  etc., 
enameled  or  vitrified  tiles  of  various  types  are  used. 

PAPERING.  —  The  papering  of  walls  and  ceilings  is  unhygienic  and 
not  permissible  in  ba-rracks,  hospitals  and  other  buildings  occupied 
by  a  number  of  men.  In  private  houses  it  is  still  more  or  less  used 
for  economic  and  esthetic  reasons.  Paper  presents  an  absorbent 
surface  and,  together  with  the  paste  used,  furnishes  not  only  a  rest- 
ing place  for  the  germ-laden  dust  but  also  a  culture  medium  for  the 
growth  of  bacteria.  Bright  green  and  red  papers  should  be  avoided 
for  they  probably  contain  arsenic  and,  when  detached  from  the  wall, 
may  give  off  arsenical  vapor.  In  repapering  a  wall,  the  old  paper 
must  always  be  removed  and  the  surface  scraped  before  the  new 
paper  is  laid  on. 

FLOORS.  —  The  ideal  floor,  in  temperate  and  warm  countries,  is  a 
hard,  smooth,  impenetrable  mineral  floor,  free  from  open  joints  and 
crevices,  one  that  can  be  washed  and  scrubbed  without  danger  of 
dampness,  decay  and  shrinking,  and  that  affords  no  harbor  of  refuge 
to  vermin  and  dust.  But  the  expense  and  weight  of  such  floor  ren- 
der it  too  often  prohibitive;  it  is  also  open  to  the  objection  of  being 
uncomfortable  in  cold  weather. 

The  material  most  used  for  flooring  is  wood.  It  should  be  laid  in 
two  layers,  with  a  thickness  of  flooring  felt  between,  the  lower,  of 
boards  laid  diagonally,  close  together,  and  the  upper  of  tongued  and 
grooved  boards.  For  lavatories,  latrines  and  other  places  whose 
floors  need  frequent  washing,  an  impervious  material  is  necessary, 
such  as  cement,  asphaltum,  "  terrazo  "  (made  of  small  pieces  of 
marble  laid  in  cement  and  smoothed  down),  or  various  types  of 
mineralized  wood  pulp  for  which  are  claimed  the  combined  advan- 
tages of  wood  and  stone.  In  tropical  countries,  tiles  or  marble  slabs 
laid  in  cement  make  perfect  floors. 

Between  the  floor  above  and  the  ceiling  below  there  is  often  an 
empty  space.  This  is  an  advantage,  as  it  deadens  sounds  and  pre- 


482  MILITARY    HYGIENE. 

vents  heat  conduction.  It  is  essential,  however,  that  it  should  not 
become  a  receptable  for  organic  matter  passing  through  the  cracks 
and  defective  joints  of  the  flooring,  and  liable  to  be  stirred  up  by 
air  currents  and  contaminate  the  air  of  the  room  above.  This  is 
rendered  impossible  with  a  tiled  floor  properly  laid  in  cement,  or  a 
wooden  floor  resting  on  a  ceiling  of  hollow  tile  or  reinforced  con- 
crete, especially  if  imbedded  in  asphaltum. 

But  the  organic  dust,  full  of  micro-organisms,  which  constantly 
accumulates  on  the  wooden  floor  of  inhabited  rooms,  especially  bar- 
racks, finds  lodgment  in  the  joints,  cracks  and  all  interstices,  how- 
ever minute;  it  is  constantly  raised  by  air  currents,  as  well  as  by 
sweeping  and  dusting,  and  a  menace  to  the  occupants.  Furthermore, 
any  moisture  applied  to  an  unprotected  wooden  floor  will  cause  it  to 
expand,  crack  and  decay.  Hence  the  necessity  of  filling  and  closing 
up  all  places  capable  of  harboring  dust  and  vermin,  and  to  render 
the  wood  impervious  to  water.  Coal  tar,  diluted  with  heavy  coal  oil, 
has  long  been  used  for  these  purposes  in  French  barracks,  but  lately 
was  replaced  by  carbonyle.  (coal-tar  product)  which,  besides  render- 
ing the  wood  impermeable,  possesses  also  bactericidal  and  para- 
siticidal  properties;  it  has  the  objection  of  imparting  a  dull  brown- 
ish tint  to  the  floor.  In  German  barracks,  boiling  linseed  oil  is 
used  once  or  twice  a  year,  but  although  undoubtedly  useful  fails  to 
fill  up  the  joints  and  cracks.  The  use  of  paraffin  and  wax  gives 
excellent  results,  but  is  too  expensive  for  general  application.  Cer- 
tain coal-oil  products,  cheap  and  easily  applied  (such  as  the  Stand- 
ard Floor  Dressing}  are  reported  to  be  very  satisfactory. 

In  our  barracks,  all  finished  wood  floors  and  stair  treads  are  simply 
given  one  coat  of  raw  linseed  oil,  well  rubbed  in.  More  complete 
treatment  is  certainly  desirable. 

WINDOWS.  —  Windows  should  extend  up  within  a  short  distance 
of  the  ceiling,  and  down  to  about  three  feet  of  the  floor.  In  cold 
and  temperate  climates  it  is  best  that  the  two  sashes  slide  vertically 
one  over  the  other,  ventilation  being  thus  more  readily  graded;  in 
warm  countries,  French  windows  descending  nearly  to  the  floor, 
with  lateral  sashes  hinged  at  the  sides  and  opening  their  whole 
length,  are  preferable.  An  excellent  combination  is  to  have  an 
independent  transom  over  the  French  window,  to  be  used  for  ven- 
tilation when  the  weather  does  not  admit  of  the  opening  of  the 
window  itself.  Doors  and  windows  must  be  protected  by  suitable 


POSTS,    BARRACKS    AND    QUARTERS.  483 

screens  against  flies  and  mosquitoes  whenever  these  insects  are 
troublesome  or  the  diseases  which  they  convey  are  prevalent.  In 
cold  countries,  double  windows  are  used  so  as  to  save  heat  and  pre- 
vent drafts ;  in  such  case,  the  outside  window  should  always  have  a 
ventilating  panel  which  can  be  opened  or  closed  to  the  desired 
extent.  In  northern  European  countries,  the  lower  part  of  the 'space 
between  the  two  windows  is  often  filled  with  wool,  a  device  to  be 
commended  only  when  the  temperature  remains  long  below  zero. 

ROOFS.  —  For  most  countries,  slate  laid  on  heavy  builder's  paper 
is  the  best  roofing  material.  Tiles  are  less  conductive,  therefore 
cooler  and  better  adapted  to  hot  climates.  Metal  roofs  become  very 
hot  and  are  therefore  objectionable  unless  they  rest  upon  a  layer  of 
coarse  cement.  When  an  emergency  requires  the  use  of  corrugated 
iron  or  other  metal,  it  should  be  laid  in  two  layers  separated  by  an 
interval  of  six  inches.  In  tropical  countries,  it  is  well  to  provide 
an  air  space,  or  attic,  between  the  top  floor  and  the  roof,  and,  be- 
tween this  attic  and  the  tiles,  to  interpose  a  layer  of  porous  cement 
laid  between  and  over  the  rafters,  consisting  chiefly  of  some  non- 
conductive  substance  (cinders,  infusorial  earth,  pozzuolana,  etc.). 

General  Specifications  for  United  States  Barracks. 

In  accordance  with  the  specifications  of  the  Chief  Quartermaster 
Corps,  our  barracks  are  two-story  and  basement  brick  buildings; 
the  exterior  basement  and  area  walls  and  piers,  of  stone ;  the 
footings  under  all  walls,  piers,  chimneys  and  iron  columns,  of  con- 
crete ;  the  superstructure,  interior  basement  walls  and  all  chimneys, 
of  brick ;  the  roof  of  building  to  be  covered  with  slate,  and  the  roofs 
of  porches,  of  tin. 

A  subsoil  drain  of  6-inch  vitrified,  hub- joint,  terra-cotta  pipe  is 
laid  outside  of  the  footings,  the  lower  third  .of  joint  cemented  and 
the  remainder  left  open.  Through  2-inch  cast-iron  pipes,  it  receives 
the  drip  from  refrigerators  and  drainage 'from  area-ways.  It  has  no 
connection  with  the  sewer. 

The  downspouts  are  of  corrugated  galvanized  steel,  provided, 
below  the  water  table,  with  cast-iron,  hub-joint  leaders  which  con- 
nect with  a  4-inch  vitrified  terra-cotta  drain  emptying  into  the  main 
drain  or  wherever  desired,  but  not  connecting  with  the  sewer. 

The  entire  basement  floor  (including  toilet  rooms,  barber  and 
tailor  shops)  is  properly  filled,  graded  and  rolled  to  a  firm  surface, 


484  MILITARY    HYGIENE. 

then  covered  with  4^2  inches  of  concrete;  before  this  has  set,  a 
finishing  coat,  half-inch  thick,  of  one  part  cement  and  two  parts 
sand,  is  put  over  it.  The  floors  of  toilet  rooms  and  shower  stalls 
are  graded  from  walls  to  floor  traps.  The  steps,  coping  and  floor 
of  each  areaway  likewise  receive  a  layer  of  concrete  and  finishing 
coat.  • 

The  stone  work  must.be  of  sound,  durable  local  stone,  of  good 
quality  of  rubble  work,  faced  full  height  on  inside,  and  below  grade 


Ifi'"  iF^HI'j! 

UJ  i     i-Li     I1      LLJ     : 


FIG.  I2&—  Standard  barrack,  U.  S.  Army.    Front  elevation. 

on  outside,  the  mortar  used  consisting  of  one  part  cement  and  three 
parts  sand.  After  basement  walls  are  well  set  and  dry,  the  outside, 
from  bottom  of  footings  to  surface  of  ground,  is  to  be  plastered  half- 
inch  thick  with  mortar  composed  of  equal  parts  of  cement  and  sand. 

No  damp-proof  courses  are  used  except  in  exceptional  cases. 

The  brick  must  be  sound,  hard,  well-burned  and  dark-red  common 
brick,  laid  with  flushed,  solid  joints;  dry  if  laid  in  frosty  weather, 
and  well  wetted  if  laid  in  dry,  hot  weather. 

The  floors  consist  of  two  layers:  the  under  layer  of  boards  not 
over  8  inches  wide,  dressed  on  upper  side  and  laid  diagonally,  close 
together,  upon  the  wood  joists ;  the  upper  layer,  of  maple  or  yellow 
pine  boards.;  tongued  and  grooved,  3)4  inches  wide,  tightly  driven 
up  and  blind  nailed ;  with  one  thickness  of  flooring  felt  between 
them  (no  tarred  paper  used). 

The  hand  rails  are  of  oak  throughout;  the  stair  treads  of  same 
wood  as  upper  floors ;  all  other  inside  finish  of  best  quality  of  white 
pine  or  yellow  poplar. 

The  entire  halls  of  basement,  first  and  second  stories  are  wain- 
scoted four  feet  high,  with  baseboard  and  cap  moulding.  All  rooms 
in  first  and  second  stories  have  baseboards,  with  moulding  at  bottom. 


POSTS,    BARRACKS    AND    QUARTERS.  485 

All  walls  and  ceilings  (except  ceilings  of  first  story  and  soffits  of 
all  stairs)  are  furred,  lathed  and  plastered;  the  plastering  consisting 
of  three  coats,  the  first  two  of  quick-setting  cement  plaster,  the  third, 
or  finishing  coat,  of  hard  white  cement-finish  troweled  to  a  smooth 
surface.  The  stone  walls  in  toilet  rooms  are  given  a  coat  of  plaster 
made  of  one  part  of  Portland  cement  and  three  parts  of  sand  applied 
directly  to  the  stone  and  floated  smooth  and  even. 

All  ceilings  of  first  story  and  soffits  of  all  stairs,  on  account  of  the 
great  jarring  to  which  exposed,  are  covered  with  one  thickness  of 
heavy  flooring  felt  and  then  cross-furred  with  strips  properly  spaced 
to  receive  steel  ceiling  plates.  These  plates,  about  20  inches  square, 
have  lock  slips  or  countersunk  joints  with  no  ornament  of  any  sort 
except  in  extreme  corners  to  conceal  wrinkles. 

All  roofs  of  building  (except  where  tin  is  specified)  and  the  walls 
of  dormers  are  covered  with  the  best  quality  of  'unfading  black  slate. 
Before  laying  the  slate,  the  roof  is  covered  with  a  thickness  of  best 
red-rope,  waterproof  sheathing  paper,  free  from  wood  pulp  and 
rosin.  The  roof  of  all  porches  is  covered  with  tin,  in  locked  and 
soldered  plates,  laid  on  one  thickness  of  flooring  felt. 

All  outside  wood  and  metal  work  (except  copper  and  tin)  are 
painted  three  coats  of  paint  made  of  white  lead  mixed  with  linseed 
oil,  the  last  coat  to  be  one-third  zinc  white.  Tinwork  receives  one 
coat  of  mineral  paint  on  under  side  and  two  on  upper  side.  All 
interior  woodwork  and  exposed  iron  columns  are  painted  three  coats 
of  paint  made  of  equal  parts  of  white  lead  and  zinc  white  mixed  in 
Unseed  oil.  The  walls  of  each  toilet  room  receive  two  coats  of  lead 
and  oil  paint  and  a  third  coat  of  white  enamel  paint. 

DISTRIBUTION  OF  ROOMS.  —  The  basement  and  two  stories  of  bar- 
racks are  generally  assigned  to  the  following  uses,  as  shown  in  Figs. 
129,  130,  131.  In  the  basement  is  the  lavatory,  containing  water- 
closets,  urinals,  wash-bowls,  laundry  tubs,  4  to  6  showers  and  one 
bath-tub.  On  the  first  floor  is  the  kitchen,  with  pantry,  store-room 
and  cook's  room;  mess-room;  company  office,  with  adjoining  store- 
room and  clerk's  room ;  a  large  recreation  room ;  first  sergeant's 
room ;  one  dormitory.  On  the  second  floor  are  only  dormitories, 
with  separate  rooms  for  non-commissioned  officers. 

This  arrangement  is  entirely  satisfactory.  The  location  of  the 
lavatory  in  the  basement,  assuming  that  the  plumbing  is  perfect,  is 
quite  unobjectionable;  it  is  of  convenient  access  and  is  heated  in  the 


486 


MILITARY    HYGIENE. 


easiest  and  most  economical  way  possible.  The  kitchen  and  mess- 
room  are  properly  placed  on  the  first  floor,  the  kitchen  in  a  wing  and 
the  mess-room  in  the  main  building;  a  large  hood  over  the  hearth 
carries  off  all  odors  so  that  none  are  detected  in  any  other  part  of 
the  barrack.  It  is  a  recognized  principle  in  hygiene  that  dormitories 
should  be  as  high  as  possible  above  the  soil;  it  is  therefore  one  of 
the  advantages  of  a  2-story  barrack  that  the  upper  floor  can  be 
exclusively  used  for  dormitories. 


m 


H 


FIG.  129. —  Standard  barrack,  U.  S.  Army.     Basement  plan. 

Sometimes  lavatories  are  detached  (Fig.  132),  each  being  placed 
in  rear  of  its  corresponding  barrack.  This  may  be  rendered  neces- 
sary by  the  difficulty  of  getting  a  suitable  outlet  for  the  excreta  and 
wastes  at  a  lower  level ;  but,  all  things  considered,  it  is  less  desirable 
than  a  properly  installed  basement  lavatory.  When  thus  detached 
it  generally  contains  the  barber  shop  and  tailor  shop. 

Several  of  our  large  posts  are  provided  with  general  messes,  that 
is  to  say,  with  one  common  kitchen  and  mess-room  for  the  several 
organizations  of  the  garrison.  Such  messes  have  decided  advan- 


POSTS,    BARRACKS    AND    QUARTERS. 


487 


DAY 
ROOM 


FIG.  130. —  Standard  barrack,  U.  S.  Army.     First  floor  plan. 


FIG.  131. —  Standard  barrack,  U.  S.  Army.     Second  floor  plan. 


M1L1TARV    HYGIENE. 


tages,  provided  they  are  managed  by  competent  and  interested 
officers ;  they  are  more  economical,  admit  of  a  higher  grade  of  cook- 
ing, are  more  easily  supplied  and  their  wastes  more  readily  disposed 
of.  Notwithstanding  all  this,  there  is  a  general  opinion  that  separate 
company  messes  are  preferable,  inasmuch  as  each  company  trains 
its  own  cooks  and  is  always  ready  to  take  the  field  independently. 


FIRST  FLOOR  PLAN 

FIG.   132. —  Detached  company  lavatory. 


FIG.  133. —  Double  company  kitchen  and  mess  hall. 


POSTS,    BARRACKS    AND    QUARTERS. 


489 


Besides,  companies  may  thus  benefit  from  the  careful  and  thrifty 
management  of  their  officers  and  indulge  in  such  delicacies  as  their 
resources  permit. 

When  barracks  are  so  planned  that  kitchens  and  mess-rooms  have 
to  be  detached,  a  very  convenient  and  economical  arrangement  is 
that  illustrated  in  Fig.  133,  in  which  two  sets  are  contiguous  and 
under  the  same  roof.  This  is  particularly  suitable  for  barracks  dis- 
posed in  double  sets. 


FIG.  134. —  Barrack  bedstead. 

The  features  which  should  characterize  barracks  in  the  tropics  are 
described  in  the  chapter  on  Service  in  Warm  Climates. 

Furniture  and  Bedding. 

All  woodwork  and  furniture  in  barracks  should  be  of  the  simplest 
kind  and  easily  accessible,  with  as  few  recesses,  angles,  mouldings, 
projections  and  open  shelving  as  possible  to  avoid  the  accumulation 
and  dissemination  of  dirt  and  dust. 


490 


MILITARY    HYGIENE. 


Wainscoting  is  superfluous  and  harmful  in  barracks,  affording 
refuge  to  vermin  and  rodents. 

The  bedstead  now  provided  for  enlisted  men  is  above  criticism. 
It  is  entirely  of  metal,  the  link-meshed  spring  bottom,  or  "  fabric," 
being  9  meshes  wide  by  16  meshes  long,  in  all  65  inches  long  and 
'3 1 26  wide,  and  connected  to  rail  at  each  end  by  19  spiral  springs. 
Head  and  foot  pieces  have  mosquito-bar  rods.  (Fig.  134.) 

The  bedding  consists  of  mattress,  mattress  cover,  pillow,  pillow 
cases,  bed  sacks,  pillow  sacks,  mosquito-bars,  sheets  and  blankets. 
The  mattress  consists  of  narrow-striped  blue  and  white  ticking 
filled  with  one  unbroken  sheet  of  interlaced  carded  cotton  felt. 
(Fig.  135.)  For  protection  it  is  enclosed  in  a  cover  of  unbleached 
cotton  duck.  The  pillow  is  made  of  the  same  material,,  and  enclosed 
in  cases  of  unbleached  muslin.  The  bed  sacks,  of  unbleached  cotton 
drilling,  and  pillow  sacks,  of  unbleached  cotton  duck,  are  intended 


FIG.   135. —  Mattress  of  felted  cotton,  for  use  with  barrack  bedstead. 

to  take  the  place  of  mattresses  and  pillows  in  the  field,  stuffed  with 
hay  or  grass.  Mosquito-bars  are  indispensable  in  garrison  and 
field,  wherever  malaria  and  yellow  fever  prevail,  and  stringent  orders 
should  be  issued  to  insure  their  proper  use.  The  sheets  are  of  un- 
bleached sheeting,  90  inches  long  and  48  wide.  The  blanket,  of 
olive-drab  woolen  material,  is  7  feet  long,  5^2  feet  wide,  and  weighs 
3  pounds.  It  is  provided  with  tapes  along  sides  and  bottom  to  per- 
mit its  being  folded  into  a  sleeping  bag  (see  under  Equipment). 

All  soiled  clothing  is  placed  in  a  "  barrack  bag  "  of  brown  cotton 
duck,  32  inches  deep  and  15  in  diameter. 

Lockers.  —  Each  enlisted  man  is  supplied  with  two  lockers,  a 
"  metallic  wall  locker  "  attached  to  the  wall  and  a  permanent  fixture 


POSTS,  BARRACKS  AND  QUARTERS. 


491 


of  the   squad-room    (Fig.    136),  and  a  "trunk  locker"   which  he 
carries  with  him  whenever  changing  station. 

The  wall  locker  is  con- 
structed of  sheet  steel,  var- 
nished and  finished  in  oak  or 
olive  green;  7  feet  4  inches 
high  in  rear,  but  only  6  feet 
8  inches  in  front  on  account 
of  sloping  top  ;  19  inches  deep 
and  20  inches  wide  (when 
single).  The  door  is  per- 
forated for  ventilation  by  12 
slots,  with  hood  to  prevent 
the  settling  dust  from  getting 
to  the  contents.  Eleven 
hooks  are  provided,  3  in  each 
wall  and  2  double  ceiling 
hooks,  all  triple  brass  plated. 
These  lockers  may  be  single, 
but  are  generally  double, 
treble  or  quadruple. 

The  trunk  locker  is  a  rec- 
tangular box  30  inches  long, 
16  inches  wide  and  12  inches 
deep,  inside  measurement.  It  has  a  tray  2^4  inches  deep,  divided 
into  3  equal  compartments.  It  is  made  of  wood  in  3-ply  veneer, 
with  outside  covering  of  vulcanized  hard  rubber  bound  on  the  cor- 
ner edges  with  vulcanized  fiber  and  clamped  at  the  corners. 


FIG.  136. —  Metallic  wall  locker,  double. 


CHAPTER  XXXIX. 
POSTS,  BARRACKS  AND  QUARTERS    (CONTINUED). 

CARE   OF  BARRACKS  AND  GUARD-HOUSE. 

Barracks,  kitchens  and  mess-rooms  should  be  as  neat  and  clean 
at  all  times  as  conditions  permit.  This  is  one  of  the  practical  tests 
of  the  competency  of  company  commanders.  The  officer  who 
knows  how  to  look  after  the  comfort  and  health  of  his  men  in  gar- 
rison can  generally  be  depended  upon  to  give  a  good  account  of 
himself  in  the  field. 

The  temperature  of  barracks  and  guard-house  must  never  exceed 
70°  in  winter.  It  need  not  be  absolutely  uniform;  on  the  contrary, 
a  certain  range  of  variations  (say  from  60°  to  70°)  is  desirable  to 
produce  the  cutaneous  stimulation  most  conducive  to  active  metab- 
olism (see  under  Heating).  Ventilation  by  perflation,  through 
doors  and  windows,  is  the  most  satisfactory;  in  cold  weather  this 
should  be  done  mostly  when  the  men  go  out  for  mess,  drill  or  other 
duty. 

Most  of  the  dirt  and  dust  in  barracks,  guard-house  and  other 
buildings  is  carried  in  on  the  feet.  This  should  be  reduced  to  a 
minimum  by  the  use  of  scrapers  and  metallic  mats  at  the  doors. 
The  tendency  of  soldiers  to  accumulate  property  and  fill  their  lock- 
ers and  other  available  spaces  should  be  restrained ;  all  superfluous 
objects  diminish  the  air  space,  favor  the  collection  of  dust  and 
germs,  and  interfere  with  sweeping  and  policing.  A  space 'Sufficient 
for  cleaning  and  inspecting  should  be  left  between  the  bedsteads 
and  the  wall. 

The  bedding  soon  gathers  dirt  and  dust  from  the  body,  clothing 
and  surrounding  objects ;  it  should  be  taken  out,  well  shaken  and 
sunned  a  few  hours  once  a  week  whenever  the  weather  permits. 
Sheets  and  pillow-cases  must  be  changed  weekly  or,  at  least,  before 
they  become  visibly  soiled.  It  is  well  to  make  irregular  inspections 
of  the  beds  for  unclean  clothing  and  forbidden  articles  stowed  be- 
neath the  mattress  or  under  the  pillow.  All  soiled  linen  must  be 
sent  to  the  laundry  every  Monday,  or  other  specified  day,  and  not 
be  allowed  to  accumulate  in  bags  or  other  receptacles. 

492 


POSTS,     BARRACKS    AND    QUARTERS     (CONTINUED).  493 

The  guard-house  is  more  exposed  to  dirt  and  vermin  pollution 
than  any  other  part  of  a  garrison,  and  requires  correspondingly 
strict  supervision  and  policing.  The  prison  room,  with  occupants 
and  contents,  must  be  visible  from  end  to  end,  as  provided  by  exist- 
ing plans,  so  that  accumulation  of  soiled  clothing,,  foodstuffs  or  other 
unauthorized  or  superfluous  articles  be  easily  guarded  against.  The 
heat  must  be  kept  down  in  winter  and  plenty  of  fresh  air  constantly 
provided.  Concrete  floors  and  well-plastered  walls  are  necessary 
to  prevent  the  harboring  and  breeding  of  vermin.  Unless  the  sani- 
tary condition  of  the  guard-house  be  very  satisfactory,  the  bedding 
and  clothing  of  prisoners  should  be  subjected  to  some  form  of 
fumigation  before  being  returned  to  barracks. 

Floors.  —  In  addition  to  the  dust  which  settles  upon  them,  the 
floors  of  barracks  are  constantly  contaminated  by  mud  and  dirt 
brought  from  the  outside,  by  sputum,  fragments  of  food  and  various 
organic  debris  shaken  from  the  clothing  and  bedding.  All  these 
impurities  as  they  dry  and  become  ground  into  a  fine  dust  by  the 
tramping  of  shoes,  are  raised  by  air  currents  and  made  part  of 
the  atmosphere  breathed  by  the  occupants.  Therefore  to  clean 
the  floors,  walls  and  furniture  without  raising  and  scattering  the  dust 
and  contaminating  the  air  is  a  vital  hygienic  desideratum.  It  is  evi- 
dent that  the  ordinary  method  of  dry  sweeping  and  dusting  is  ineffi- 
cient and  may  be  worse  than  useless  since  much  of  the  dust,  if  not 
the  whole  of  it,  is  simply  scattered  through  the  room  to  again  settle 
over  the  same  or  other  parts  of  it ;  meanwhile  it  pollutes  the  air 
and  is  much  more  'dangerous  than  if  it  had  been  left  undisturbed. 
Floors  should  not  be  swept  but  cleaned  with  damp  mops.  The  pro- 
cess consists  in  dipping  the  mop  in  a  bucket  of  water,  wringing  out, 
rubbing  the  floor,  then  washing  and  rinsing  it  in  another  bucket  of 
water.  Dust  should  be  removed  by  catching  it  on  damp  cloths 
rubbed  on  the  woodwork  and  furniture,  especially  all  ledges,  mould- 
ings and  shelving.  The  feather  duster  has  become  obsolete.  The 
soldier's  former  way  of  cleaning  floors  by  pouring  streams  of  water 
upon  them,  preparatory  to  sweeping  and  scrubbing,  is  pernicious 
and  should  never  be  permitted.  It  fills  the  joints,  fissures  and  holes 
with  moisture,  thus  promoting  the  breeding  of  micro-organisms,  be- 
sides causing  the  wood  to  warp,  crack  and  decay.  Scrubbing  is  the 
best  method  of  cleaning  mineral  floors  (tile,  marble,  terrazo,  etc.)  ; 
it  may  also  be  necessary  for  wooden  floors  when  very  much  soiled, 


494  MILITARY    HYGIENE. 

but  it  must  be  done  with  as  little  water  as  possible ;  in  such  case  the 
better  plan  would  be  to  detach  and  disintegrate  muddy  or  incrusted 
spots  with  a  wet  stiff  brush,  previous  to  mopping  the  floor. 

An  excellent  system,  to  prevent  the  raising  of  dust,  consists  in 
coating  the  floor  with  an  agglutinative  dressing*  to  which  the  dust 
adheres,  but  from  which  it  is  easily  removed  by  a  stiff  broom,  in 
little  particles  too  heavy  to  rise  and  float  in  the  air.  In  barracks 
or  other  buildings  where  the  wear  is  unusually  heavy,  an  application 
every  2  or  3  months  is  necessary.  Properly  put  on,  such  dressing 
catches  and  holds  every  atom  of  dust  coming  in  contact  with  it,  thus 
saving  much  labor  in  sweeping  and  scrubbing ;  it  is  also  an  excellent 
preservative  of  wood  and  a  repellant  of  insects  and  vermin. 

In  this  connection  may  also  be  mentioned  the  vacuum  cleaning 
system  whereby  all  dust  is  completely  removed  by  suction  from  car- 
pets, hangings,  upholstery  and  decorations  without  the  least  air  pol- 
lution. Wood  and  tile  floors  are  cleaned  in  the  same  manner,  pre- 
vious to  mopping.  An  obvious  advantage  of  this  system  is  the 
pumping  out  and  removal,  together  with  the  dust,  of  much  of  the 
musty  and  germ-laden  air  which  too  frequently  stagnates  in  obscure 
corners  and  clings  to  upholstered  furniture. 

Spittoons.  —  The  sputum  is  frequently  contaminated  with  the 
germs  of  tuberculosis,  diphtheria,  pneumonia  and  other  diseases, 
generally  without  the  knowledge  of  the  man  ejecting  it;  therefore 
it  is  a  source  of  great  danger  and  every  precaution  must  be  taken 
to  prevent  its  dissemination  in  the  air,  especially  in  rooms  occupied 
by  a  number  of  people.  Spittoons  or  cuspidors  should  be  provided 
in  sufficient  number,  and  punishment  swiftly  inflicted  upon  any  one 
guilty  of  spitting  on  the  floor.  Cuspidors  must  be  emptied  and 
washed  daily,  preferably  in  boiling  water,  and  then  partly  filled  with 
a  disinfecting  solution.  They  must  be  so  shaped  as  not  to  easily 
upset,  and  to  permit  easy  cleaning.  They  should  be  set  upon  a 
square  piece  of  linoleum,  rubber  matting  or  other  washable  material, 
so  as  to  save  the  surrounding  floor  from  possible  pollution. 

Insects  and  Vermin.  —  The  various  insects  liable  to  infest  bar- 
racks and  other  buildings  need  careful  attention.  Flies  and  mos- 
quitoes are  best  guarded  against  by  screening  the  doors  and  win- 
dows, and  the  use  of  mosquito  bars.  Their  prevention  and  destruc- 
tion are  described  in  other  chapters. 

*  Such  as  the  Standard  Oil  Dressing,  one  of  the  best  known  and  most 
extensively  used. 


POSTS,     BARRACKS    AND    QUARTERS     (CONTINUED).  495 

Bedbugs  are  not  only  the  most  noisome  and  troublesome  of  the 
insects  infesting  barracks,  but  are  also  capable  of  conveying  disease 
(see  page  143).  Therefore  every  effort  should  be  made  to  exclude 
them,  or  to  exterminate  them  after  their  invasion.  The  frequent 
examination  of  the  bedding  and  clothing  is  necessary,  as  well  as  of 
the  linen  returned  from  the  wash.  They  are  destroyed  by  subject- 
ing all  infested  clothing  and  bedding  to  the  action  of  steam  under 
pressure  in  a  large  disinfecting  chamber,  or  boiling  them  in  water. 
With  iron  beds,  fire  can  be  used,  alcohol  being  poured  into  all  the 
crevices  and  immediately  ignited.  An  emulsion  of  petroleum  (i  to 
3  or  4  of  water)  may  be  applied  with  a  stout  brush,  or  else  a  spray 
of  benzine  or  gasoline,  in  the  cracks  of  the  woodwork  and  bedding. 
Such  cracks  should  then  be  filled  with  putty,  or  covered  with  strips, 
and  painted  over.  A  saturated  solution  of  corrosive  sublimate  is 
efficacious  but  cannot  be  applied  to  metals.  Insect  powder  is  use-» 
less ;  it  has  only  a  stupefying  action  upon  the  insects  and  no  effect 
upon  the  eggs.  If  a  whole  barrack  be  infested,  thorough  sulphur 
fumigation  is  best ;  formaldehyde  gas  cannot  be  relied  upon  for  this 
purpose.  Hydrocyanic  acid,  generated  from  potassium  cyanide  by 
the  addition  of  sulphuric  acid,  is  very  efficient  against  bugs  and  all 
kinds  of  vermin,  but  is  such  a  deadly  gas  that  only  experts  should 
handle  it. 

For  destruction  of  fleas,  see  page  146. 

CARE    OF    KITCHEN    AND    MESS-BOOM. 

The  personnel  required  for  duty  in  the  company  mess  consists 
of  a  mess  sergeant,  cook,  assistant  cook,  mess-room  orderly  and 
2  or  3  cooks'  police,  according  to  the  size  of  the  company.  Such  a 
personnel  permits  a  suitable  division  of  labor  and  an  orderly  and 
systematic  management  of  the  mess.  The  first  requirement  from 
these  men  is  cleanliness,  in  their  persons  and  in  all  parts  of  the 
kitchen  and  mess-room  for  which  they  are  responsible.  The  cook 
and  assistant  cook  wear  white  clothing,  aprons  and  caps.  The 
others,  if  not  provided  with  white  clothing,  should  at  least  wear 
a  high  white  apron.  The  hair  and  beard  or  mustaches  must  be 
kept  trimmed  and  well  brushed.  The  hands  demand  special  atten- 
tion, since  it  is  mostly  through  them  that  food  is  liable  to  be  in- 
fected. The  nails  must  be  kept  short  and  clean.  The  rule  that 
all  men  should  wash  their  hands  after  visiting  the  toilet-room  applies 


496  MILITARY    HYGIENE. 

with  particular  force  to  cooks  and  others  detailed  for  duty  in  the 
kitchen.  The  latter  must  also  wash  their  hands  whenever  they  are 
soiled  and  always  before  serving  the  meals.  It  is  therefore  neces- 
sary to  provide  a  place  for  the  purpose  where  soap,  towels  and  nail- 
brushes are  kept. 

Before  detailing  a  man  in  the  kitchen  or  mess-room,  the  possibil- 
ity of  his  being  a  carrier  of  typhoid  fever  or  other  infectious  dis- 
ease prevailing  in  the  vicinity,  such  as  dysentery  or  cholera,  must 
be  considered;  in  case  of  doubt  he  should  be  rejected  or  else  sub- 
mitted to  a  bacteriological  examination.  Likewise  unfit  for  such 
duty  is  any  man  with  venereal  disease  of  any  kind,  tuberculosis  or 
conspicuous  skin  eruptions. 

Cats,  dogs  and  other  pets,  as  well  as  all  men  not  on  duty  therein, 
must  be  excluded  from  kitchen  and  mess-room. 

The  kitchen  floor  is  normally  a  hard,  smooth  mineral  floor ;  it 
should  be  scrubbed  every  morning  with  soap  and  lye,  and,  besides, 
swept  and  mopped  after  dinner  and  supper.  The  kitchen  table  is 
scrubbed  after  preparing  each  meal.  Rubbing  off  the  range  with 
a  greasy  cloth  keeps- it  in  far  better  condition  than  stove  polish  ap- 
plied once  a  week.  Metallic  surfaces  and  tinware  are  cleaned  with 
soap,  sapolio,  lye,  or  with  a  cloth  sprinkled  with  kerosene. 

The  ice-chest  deserves  special  attention.  The  tendency  of  cooks 
is  to  overcrowd  it.  Articles  with  decided  odors,  like  cheese,  bacon, 
etc.,  and  others  which  do  not  readily  spoil,  had  better  be  kept  out 
of  it,  in  a  properly  screened  box.  Milk  and  butter  are  especially 
absorbent  of  smells  and,  if  possible,  should  be  kept  in  a  separate 
compartment. 

Meats  from  cold  storage  should  be  consumed  without  delay. 
Freshly  slaughtered  meats,  on  the  contrary,  improve  in  flavor  and 
digestibility  if  kept  a  suitable  time,  according  to  the  weather.  After 
being  cooked  and  seasoned,,  all  foods  should  be  consumed  as  soon 
as  possible.  Likewise,  fruit  and  meat  cans,  .once  opened,  should 
have  their  contents  used  up  within  a  day  or  two.  Foods  fermented, 
sour  or  decayed,  are  unfit  for  use ;  but  a  short,  recent  growth  of 
mold  on  meat,  cheese,  jam  and  preserves  is  not  a  necessary  sign  ol 
decay,  and,  after  being  scraped  out,  such  article  can  usually  be 
safely  eaten. 

All  wastes  and  scrapings  from  plates  are  thrown  into  a  pail  which 
is  frequently  emptied  into  the  garbage  can  (kept  outside  the 
kitchen)  and  washed. 


POSTS,     BARRACKS    AND    QUARTERS     (CONTINUED).  497 

Cockroaches  are  a  common  pest  of  kitchens  and  pantries,  espe- 
cially when  carelessly  kept.  They  are  most  numerous  where  grease 
and  food  fragments  are  left  in  sinks,  scattered  on  the  floor,  or  in 
garbage  pails.  For  their  destruction  see  page  148. 

The  mess-room  should  not  only  be  a  model  of  cleanliness,  but 
must  also  be  made  cheerful  and  attractive.  The  old  practice  of 
covering  the  tables  with  oilcloth  is  unhygienic.  They  should  be 
scrubbed  once  a  day  with  soap  and  hot  water,  and  the  stools  also 
wiped  daily  with  a  clean,  damp  cloth.  The  floor  is  mopped  every 
morning  and  swept  after  each  meal.  Nothing  is  more  attractive 
and  cheering  in  the  mess-room  than  scrupulously  clean  crockery- 
ware,  forks  and  spoons.  The  forks  need  special  care  to  wipe  off 
the  grease  and  food  particles  lodging  between  the  prongs.  The 
dishes  should  be  served  neatly,  in  an  appetizing  way;  good  service 
has  a  decided  favorable  effect  upon  digestion,  not  only  by  the  con- 
tentment it  promotes  but  also  by  its  undoubted  psychic  influence 
upon  the  secretions  of  the  digestive  organs. 

All  the  men  should  come  to  the  mess-room  with  clean  hands  and 
face,  and  neatly  dressed  in  the  uniform  prescribed. 


CHAPTER  XL. 
MILITARY  HOSPITALS. 

The  typical  post  hospital  consists  of  a  main  or  administration 
building,  with  a  wing  on  one  side  or  both  sides  of  it  according  to 
the  number  of  patients  -to  be  accommodated,  the  main  building  and 
wings  consisting  of  basement,  two  stories,  and  attic.  In  the  main 
building  are  the  various  administrative  services,  while  the  wings  are 
exclusively  used  for  wards  and  their  annexes.  When,  on  account 
of  an  increased  garrison,  such  hospital  is  no  longer  adequate,  it  is 
usually  enlarged  by  an  addition  in  rear  of  the  administration  build- 
ing and  parallel  with  it  so  that  the  central  halls  of  both  structures 
are  in  line  and  connected  by  a  covered  way.  In  this  addition  are 
transferred  the  kitchen  and  mess-room,  as  well  as  the  isolation  and 
prison  wards,  dormitories,  etc.  At  all  of  our  large  posts  a  separate 
annex,  entirely  detached  'from  the  hospital  building  and  supplied 
with  all  necessary  disinfecting  appliances,  is  erected  for  the  treat- 
ment of  infectious  diseases.  (See  chapter  on  Disinfection.) 

The  administration  building  of  the  post  hospital  is  mostly  without 
verandas,  but  usually  has  a  front  porch  over  the  main  .entrance, 
corresponding  to  a  balcony  on  the  second  floor.  The  wings  are 
provided  with  verandas  on  each  floor  and  on  both  sides,  the  upper 
and  lower  verandas  being  connected  by  stairways. 

In  the  administration  building  the  arrangement  is  as  follows: 
In  the  basement  are  the  boiler  room  with  water  or  steam  heating  ap- 
paratus, heater  room  to  supply  hot  water  throughout  the  building, 
fuel  room,  store-rooms,  dead  room,  lavatory,  etc.  On  the  first 
floor  (Fig.  137)  is  an  ample  vestibule,  with  dispensary  and  room  for 
pharmacist  on  one  side  and,  on  the  other  side,  offices  for  the  surgeon 
and  his  assistant ;  further  back  are  the  kitchen,  pantry  and  mess- 
room.  On  the  second  floor  (Fig.  138)  are  the  operating  room, 
sterilizing  room,  instrument  room,  surgical  ward,  surgeon's  toilet, 
laboratory,  recreation  room,  linen  room  and  n.-c.  o.  room.  In  the 
attic  are  the  isolation  ward  with  toilet,  prison  ward  with  toilet,  and 
dormitories  for  hospital  corps  men,  also  with  toilet. 

The  wing  is  73  feet  7  inches  long,  with  both  stories  exactly  alike. 

498 


MILITARY    HOSPITALS. 


499 


On  entering  it  from  the  main  building,  there  is  a  lavatory  on  one 
side  and  a  bath-room  on  the  other,  each  n  feet  9  inches  long.  The 
rest  of  the  wing,  on  each  floor  is  occupied  by  the  ward;  this  is  60 
feet  9  inches  long  and  23  feet  wide,  inside  measurement.  It  is 
lighted  by  4  windows  on  each  side  and  2  at  the  end,  and  contains  16 
beds  in  two  rows,  namely,  two  beds  between  the  windows  and  one 
near  each  corner.  The  heating  is  by  the  direct-indirect  system,  the 


DDDDDDDQ 

Ward 

1DDDDDDDD 


FIG.  137. —  Standard  post  hospital  for  36  beds.     First  floor. 

hot  water  or  steam  radiators  being  placed  under  the  windows.  The 
ventilation  is  effected  by  two  aspirating  shafts,  20  x  22  inches,  placed 
in  the  inner  wall ;  two  outlets  (lower  and  upper)  open  in  each  shaft. 
The  general  specifications  governing  the  construction  are  mostly 
the  same  as  those  already  described  for  barracks.  The  entire  struc- 
ture, with  exception  of  the  concrete  footings  and  stone  foundations, 


DDDDDDDD 

Ward       . 

nnDDDDDD 


FIG.  138. —  Standard  post  hospital  for  36  beds.    Second  floor. 


500 


MILITARY    HYGIENE. 


is  of  brick.  All  exterior  walls  are  built  hollow,  the  "  shells  "  being 
tied  together  with  galvanized  steel  ties  every  sixth  course.  The 
walls  and  ceilings  are  lathed,  plastered  and  hard  finished.  The  base- 
ment floor  is  of  concrete ;  the  floors  of  first  and  second  stories,  ex- 
cept as  noted  below,  are  of  wood,  rarely  of  reinforced  concrete 
finished  with  cement.  The  exterior  walls  in  contact  with  earth, 


FIG.  139. —  Post  hospital  in  the  Tropics. 


FIG.  140. —  Post  hospital  in  the  Tropics.    First  floor  plan. 


MILITARY    HOSPITALS. 


501 


from  bottom  of  footings  to  the  grade  line,  are  given  a  heavy  coat  of 
boiling-hot  asphaltum,  or  similar  waterproofing  compound,  and  plas- 
tered over  with  cement  mortar.  All  interior  walls  receive  a  damp- 
proof  course  a  few  inches  below  the  floor  level,  composed  of  two 
layers  of  waterproofing  felt  cemented  with  hot  asphaltic  cement,  or 
of  slates  imbedded  in  cement. 

The  floors  of  all  lavatories,  toilet  rooms,  operating  room  and  its 
annexes  are  of  2-inch  hexagonal,  vitreous,  white  tiles,  with  border 
of  one  row  of  3  x  6  inches  glazed  white  tiles.  All  rooms  having  tile 
floors  are  likewise  tile  wainscoted,  5  feet  high  in  operating  room  and 
annexes,  and  4  feet  high  in  the  other  rooms,  with  3x6  inches  glazed 
white  tiles  having  concave  base  and  rounded  top,  curved  angles  at 


FIG.  141. —  Post  hospital  in  the  Tropics.     Second  floor  plan. 

corners  and  rounded  return  at  openings.  In  all  lavatories,  above 
basement,  the  partitions  are  usually  of  Italian  marble  around  bath- 
tubs, water-closets,  showers,  urinals,  etc.,  while  all  metal  parts  are 
of  nickel-plated  brass. 


502 


MILITARY    HYGIENE. 


All  the  walls  of  a  hospital  should  be  painted,  and  the  paint  such 
as  to  form  a  hard,  smooth  and  impervious  surface  that  may  be 
washed  with  antiseptic  solutions  and  withstand  disinfectant  fumes. 
In  the  wards  the  walls  should  receive  a  dull  non-reflective  finish, 
restful  to  the  patients'  eyes.  Otherwise,  for  the  general  trim  of  the 
hospital,  satin  or  glass-finish  enamels  are  recommended,  except 
where  tiling  may  be  preferred.  The  highest  grades  of  enamel  finish 
are  said  to  be  obtained  with  American  zinc  oxid,  ground  in  suitable 
varnish. 

All  finished  wood  floors  and  stair  treads  are  given,  by  the  con- 
tractor, two  coats  of  floor  polish,  the  last  coat  to  be  well  rubbed 
down  with  flannel  cloth  or  floor  brush.  This  polish  consists  of  par- 
affin dissolved  in  linseed  oil,  to  which  liquid  drier  and  turpentine  are 
added.  To  keep  these  floors  in  perfect  condition,  a  suitable  dress- 
ing must  be  applied  and  well  rubbed  in  at  least  once  a.  month.  In 


DDDDDDDD 

Ward 

DDDDDQDQ 


FIG.  142. —  Brigade  post  hospital  for  132  beds.     First  floor. 

our  hospitals,  this  dressing  consists  of  a  solution  of  ^2  pound  of 
paraffin  and  2  pounds  of  beeswax  in  I  gallon  of  turpentine.  Munson 
recommends  i  ounce  each  of  paraffin  and  wax  in  a  quart  of  turpen- 
tine. 


MILITARY    HOSPITALS. 


503 


Iii  the  tropics,  where  skilled  labor  is  hard  to  procure  and  the 
woodwork  often  attacked  by  boring  ants,  it  has  been  found  advan- 
tageous to  build  hospitals  and  other  public  buildings  of  iron  and 
concrete.  The  specifications  for  the  construction  of  a  military  hos- 
pital at  San  Juan,  Porto  Rico,  call  for  a  2-story  reinforced  concrete 
and  cement  structure,  with  high  ceilings,  wide  porches  and  electric 
lighting.  (Figs.  139,  140,  141.) 


DDDDDDDD 

Ward 

DDDGaDDD 


II— II 

FIG.   143. —  Brigade  post  hospital  for   132  beds.     Second  floor. 

In  the  Philippines,  large,  flat,  translucid  shells  are  extensively 
used  in  windows  instead  of  glass  panes.  They  have  the  advantage 
of  toning-  down  the  intensity  of  light  and  reflecting  the  heat  rays. 

At  large  posts,  the  hospital  assumes  various  shapes  according  to 
local  conditions,  or  as  the  result  of  several  successive  extensions,  but 
seldom  departs  materially  from  the  above  structural  specifications. 
(Figs.  142,  143.) 

General  Hospitals.  —  The  plans  of  large  permanent  hospitals,  such 
as  base  or  general  hospitals,  while  remaining  within  the  generally 
accepted  principles  of  hygiene  and  administration,  are  susceptible  of 


504 


MILITARY    HYGIENE. 


wide  variation,  according  to  the  views  of  medical  officers  and  archi- 
tects, available  means  and  peculiarities  of  site.  The  pavilion  system 
is  the  one  that  most  commends  itself,  the  pavilions  being  conven- 
iently grouped  and  so  connected  with  all  the  other  buildings  as  to 
secure  efficient  administration.  Each  pavilion  should  be  of  2  or  3 
stories,  with  a  ward  and  annexes  on  each  floor,  each  ward  to  accom- 
modate about  30  patients.  One-story  pavilions,  in  a  permanent 


FIG.   144. —  Plan  of  the  U.   S.  Army  general  hospital,   at  the   Presidio, 
San  Francisco,  Cal. 

hospital,  involve  an  unnecessary  waste  of  space  and  material,  and 
cause  a  very  inconvenient  scattering  of  wards.  The  general  hospital 
at  Presidio,  San  Francisco  (Fig.  144),  is  excellently  planned  and 
one  of  the  best  types  of  that  class,  but  open  to  the  objection  that  its 
pavilions  are  i-storied ;  the  ward,  excluding  lavatory  and  service 
rooms,  is  153  feet  long  and  accommodates  at  least  40  patients,  a 
larger  number  than  should  be  placed  in  one  room. 


MILITARY    HOSPITALS. 


Temporary  General  Hospital.  —  In  the  event  of  war,  when  prep- 
arations must  be  made  quickly  for  large  numbers  of  sick  and 
wounded,  the  pavilion  system  necessarily  imposes  itself.  The  plans 
and  specifications  for  temporary  base  and  general  hospitals,  on  this 


R.   O  /V.  O 


-NU  .SES.MESS- 


BLOCK    •     PLAN 

FIG.   145. —  Plan   for  temporary  base  hospital,   with  pavilion  wards. 

system,  are  on  file  in  the  Surgeon  General's  Office  so  that  they  can 
quickly  be  put  into  execution. 

The  buildings  are  of  simple  construction  and  can  be  erected  by 
ordinary  builders  with  material  that  can  be  purchased  in  any  market. 


506 


MILITARY    HYGIENE. 


In  the  interest  of  simplicity  a  single  type  has  been  adopted  for  all 
purposes,  and  the  various  buildings  differ  only  in  their  interior  ar- 
rangement.. They  are  all  i-story  substantial  frame  structures,  with 
walls  and  ceilings  finished  with  tongued  and  grooved,  beaded  boards, 
heated  by  stoves  and  roofed  with  corrugated  iron.  One-story  pavil- 
ions are  preferred  because  of  the  greater  simplicity  of  construction, 
the  greater  facility  of  heating  and  ventilating  and,  in  case  of  fire, 
the  lesser  risk  to  the  patients. 

Each  ward  (Fig.  146)  consists  of  a  building  120  feet  long  and  26 
feet  wide,  with  ceiling  12  feet  high,  lighted  by  10  windows  on  each 
side.  It  is  connected,  by  a  passage  10  feet  long,  with  an  annex  in 
which  are  the  lavatory  on  one  side  and  the  water  heater  on  the  other. 
In  the  end  nearest  the  annex  is  a  room  on  either  side,  one  for  special 
diet  and  the  other  for  office  and  linen.  The  ward  proper  is  106 


D  0  0  D  D 


j  D  I  D  D  I  D!!D  I  D  D  1  D  D 

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A^^rZSSiJw?     "'a  *    @«----~-|£fW/JteD*^"»«®  -*    @==«£&4+ 

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WARD    AND-  LAVATOR.Y  • 


SICnON—   WARD 


FIG.   146. —  Elevation  and  floor  plan  of  a  pavilion.     Temporary  general 

hospital. 

feet  8  inches  long  and  accommodates  26  beds,  each  patient  hav- 
ing 106  square  feet  of  floor  area  and  1,272  feet  of  cubic  space  which, 
under  the  circumstances,  is  quite  sufficient.  It  is  heated  by  5  jack- 
eted stoves  with  bent  pipes  running  up  into  ventilation  shafts.  The 
ventilation  is  effected  by  means  of  galvanized  pipes  conducting  fresh 
air  under  the  floor  to  the  stoves,  and  of  5  ventilation  shafts  which 
receive  the  smoke  pipes  and  are  topped  with  star  ventilators. 

The  general  arrangement  and  grouping  of  the  pavilions  varies 
greatly.  The  wards  may  be  set,  like  divergent  rays,  on  the  outer 
side  of  a  covered  way  shaped  like  a  horseshoe  (Fig.  145)  or  an 
inverted  letter  V,  with  all  or  most  of  the  other  buildings  inside ; 
they  may  also  be  located  on  each  side  of  a  covered  way,  or  on  two 


MILITARY    HOSPITALS. 


507 


sides  of  a  square  or  rectangle.  The  chief  objects  to  be  attained,  in 
determining  this  general  plan,  are  to  give  each  ward  a  maximum  of 
space,  light  and  sunshine,  secure  accessibility  to  all  parts  and  con- 
venience of  service,  and  provide  open,  attractive  grounds  for  the 
use  of  convalescents. 


r 


FIG.  147. —  Garrison  hospital,  Tempelhof ,  Berlin.  A,  B,  C,  D,  two-story 
buildings  for  wards  with  corridors  on  north  side ;  E,  F,  convalescent  wards ; 
G,  H,  I,  wards  for  contagious  diseases ;  a,  guard  and  telegraph ;  b,  pharmacy 
and  laboratory;  c,  administration  (3  stories),  reception  room,  quarters  for 
officers  and  nurses ;  d,  laundry,  kitchen,  distilling  and  steam  plants ;  e,  cov- 
ered passage  connecting  buildings  A  and  B ;  f,  operating  room ;  g,  chief 
surgeon's  quarters ;  h,  hospital  corps  quarters ;  i,  ice  house ;  /,  chapel,  dead- 
house,  and  vivisection  room ;  k,  store  house ;  /,  detached  ward ;  m,  disinfection 
house. 

One  of  the  best  German  types  of  military  hospitals  is  illustrated 
in  Fig.  147,  which  represents  the  Tempelhof  garrison  hospital  in 
Berlin,  with  a  capacity  for  500  beds,  but  susceptible  of  expansion  to 
600.  It  comprises  14  wards  with  16  beds  each,  27  rooms  with  6 
beds,  22  rooms  with  3  beds,  16  rooms  with  2  beds,  and  single  rooms 
for  officers.  Each  bed  has  a  cubic  air  space  of  about  37  meters 


508  MILITARY    HYGIENE. 

(1,315  cubic  feet).  It  is  under  the  direction  of  a  chief  medical 
officer,  with  personnel  of  17  medical  officers  and  125  enlisted  men. 
Some  of  its  features  are  a  gymnasium  for  the  special  exercise  and 
development  of  any  part  of  the  body,  an  experimental  biological 
laboratory,  a  model  hospital  train  all  fitted  out  (including  ward, 
kitchen,  pharmacy,  etc.),  and  6  distillation  wagons  for  the  field, 
each  capable  of  distilling  and  cooling  500  liters  per  hour. 


CHAPTER  XLI. 
AIR. 

COMPOSITION.  —  Air  is  a  mixture  of  several  g-ases,  chiefly  oxygen, 
nitrogen  and  argon,  in  the  proportion,  by  volume,  of  about  21,  78.15 
and  0.85,  respectively.  The  other  normal  constituents  of  air,  all  in 
very  small  or  minute  quantities,  are  carbon  dioxid,  ozone,  aqueous 
vapor,  ammonia,  nitrous,  nitric  and  sulphuric  acids,  and  dust.  The 
proportion  of  all  these  constituents  varies  only  within  narrow 
limits,  and  when  temporarily  disturbed  becomes  again  quickly  read- 
justed under  the  operation  of  natural  laws,  that  is  to  say,  through 
the  ceaseless  convection  currents  due  to  the  sun's  heat  and,  to  a 
lesser  extent,  the  diffusion  of  gases.  Wide  fluctuations  in  the 
oxygen  tension  of  the  air  may  occur  without  notable  disturbances  of 
the  body  functions,  until  the  proportion  falls  to  about  13  per  cent,  or 
rises  to  50,  when  adjustment  to  the  change  becomes  difficult. 

At  sea  level  and  a  temperature  of  o°  C.  the  normal  pressure  of 
the  atmosphere  is  sufficient  to  support  a  column  of  mercury  760  mm. 
(30  inches)  high,  and  amounts  to  15  pounds  on  every  square  inch 
of  surface.  This  pressure,  as  shown  by  the  barometer,  varies  within 
certain  limits,  being*  higher  when  the  air  is  cold,  dry  and  compressed 
by  upper  downward  currents,  and  lower  when  the  air  is  hot,  damp 
and  lifted  by  upward  currents.  Damp  air  is  lighter  than  dry  air 
because  the  density  of  aqueous  vapor  is  less  than  the  air,  in  the 
ratio  of  0.62  to  i. 

Oxygen  is  indispensable  to  the  maintenance  of  all  life,  animal  and 
vegetable.  Without  it  there  can  be  no  growth  or,  repair  of  tissues, 
nor  combustion  and  destruction  of  organic  and  inorganic  matter. 
In  man  and  animals,  the  oxygen  of  the  air  is  absorbed  in  the  lungs 
by  the  red  blood-corpuscles,  uniting  with  the  hemoglobin,  or  color- 
ing matter,  and  carried  by  the  arterial  current  to  all  parts  of  the 
body;  it  is  taken  up  by  the  tissue  cells,  where  it  combines  with  the 
metabolized  carbon  and  hydrogen,  the  resulting  carbon  dioxid  and 
water  being  conveyed  by  the  venous  blood  to  the  lungs  and  elim- 
inated. According  to  Prof.  Foster,  an  average  adult  inhales  a  little 
more  than  7  pounds  of  oxygen  daily,  about  one-fourth  of  which,  or 
nearly  2  pounds,  is  absorbed  by  the  lungs. 

509 


5IO  MILITARY    HYGIENE. 

Plants  breathe  like  animals  by  absorbing  oxygen  and  giving  off 
carbon  dioxid,  a  function  especially  active  during  germination  and 
blossoming;  oxygen  is  therefore  essential  to  their  growth  and  life. 

Nitrogen  is  an  inert  gas,  chiefly  serving  to  dilute  the  oxygen;  it 
takes  no  part  in  the  respiration  of  animals,  but  contributes  to  the 
nutrition  of  plants.  It  is  the  most  important  constituent,  of  animal 
tissues.  Animals  obtain  it  exclusively  from  the  vegetable  world, 
while  plants  derive  it  from  the  soil  and  the  air;  from  the  soil  out  of 
ammonia  salts,  nitrites,  nitrates  and  proteid  compounds  from  dead 
plants  and  animals ;  from  the  air  through  the  agency  of  certain 
"  nitrifying  "  bacteria  which  stand  in  symbiotic  relationship  to  the 
plant  and  enable  it  to  obtain  nitrogenous  compounds  at  the  cost  of 
the  atmospheric  nitrogen.  These  bacteria  develop  nodules,  ranging 
in  size  from  a  pin's  head  to  a  small  pea,  upon  the  roots  of  many 
plants,  particularly  species  of  the  leguminous  family  (peas,  beans, 
clovers)  which,  in  consequence,  often  thrive  in  poor  soil  and  enrich 
it.  Cultures  of  them  are  now  commercially  prepared  and  made 
available  for  sowing  in  sterile  soil  in  connection  with  suitable  plants. 
It  is  worth  noticing  that  nitrogen  is  also  one  of  the  principal  ingredi- 
ents of  explosive  powders,  so  that  if  it  is  indispensable  to  the  life  of 
animals  it  is  also  one  of  the  chief  agents  in  destroying  it. 

Argon,  so  far  as  known,  is  an  inert,  indifferent  gas. 

Carbon  dioxid  or  carbonic  acid  (CO2)  is  a  constant  but  variable 
constituent  of  air,  averaging  from  3  to  4  parts  in  10,000,  or  0.03  to 
0.04  per  cent.  In  a  dense  fog  it  may  rise  to  12  or  14  parts  in  the 
open  air  of  large  cities.  It  is  derived  from  the  respiration  of  ani- 
mals, the  combustion  of  all  substances  used  for  heating  or  illuminat- 
ing purposes,  the  oxidation,  fermentation  and  decomposition  of  all 
organic  matters,  the  eruption  of  volcanoes,  etc.  The  ground-air  is 
much  richer  in  carbon  dioxid  than  the  open  air  above,  sometimes 
reaching  100  or  more  parts  in  10,000;  by  diffusion  it  contaminates 
the  layers  next  to  the  ground  which  on  this  account  contain  much 
more  of  CO,  than  the  normal  average. 

An  adult  man  exhales  about  15  cubic  feet,  or  about  2  pounds  of 
CO2  a  day.  Illuminating  gas  gives  off  twice  its  volume  of  it.  One 
ton  of  coal,  by  its  combustion,  produces  three  tons  of  CO2.  The 
burning  of  coal,  therefore,  is  the  chief  source  of  carbon  dioxid  in 
the  atmosphere,  the  yearly  production  of  this  gas  being  estimated  at 
1,200  millions  of  tons.  Huxley  calculated  that  the  atmosphere  super- 


AIR.  511 

incumbent  upon  any  area  of  the  earth's  surface  contains  enough 
carbon  to  cover  this  area  with  a  dense  forest. 

How  is  this  great  excess  of  CO2  in  the  atmosphere  disposed  of 
and  the  normal  ratio  of  0.03  per  cent,  maintained?  Much  of  it  is 
absorbed  by  the  ocean,  since  water  takes  up  its  own  volume  of  the 
gas,  but  a  larger  proportion  is  removed  by  plants  which,  through  the 
action  of  their  green  pigment,  or  chlorophyl,  and  under  the  influence 
of  light,  decompose  it,  retaining  the  carbon  and  discharging  the 
oxygen.  Thus  it  is  estimated  that  one  acre  of  woodland  with- 
draws, in  one  season,  4^  tons  of  CO2  from  the  air,  appropriating 
il/4  tons  of  carbon  and  discharging  3^4  tons  of  oxygen.  This  func- 
tion of  plants,  carried  on  through  their  foliage,  is  a  purely  nutritive 
one  and  not  concerned  in  their  respiration,  the  oxygen  thus  returned 
to  the  air  far  exceeding  the  comparatively  small  amount  absorbed 
in  the  performance  of  the  latter  function,  and  maintaining  the  normal 
equilibrium  of  atmospheric  gases.  Since  the  decomposition  of  car- 
bon dioxid  by  plants  ceases  in  darkness,  while  their  respiration  con- 
tinues, an  increase  of  that  gas  may  be  expected  at  night  in  rooms  in 
which  plants  are  kept,  especially  when  blossoming,  if  not  properly 
ventilated. 

Ozone,  an  allotropic  form  of  oxygen,  is  a  normal  but  not  constant 
constituent  of  the  air,  being  only  found  in  the  country  and  at  sea, 
and  the  amount  increasing  with  the  altitude.  It  has  very  strong 
oxidizing  properties,  eagerly  combining  with  decaying  animal  or 
vegetable  matter,  so  that  it  quickly  disappears  wherever  such  matter 
is  abundant.  Any  locality,  therefore,  where  ozone  is  present  may 
be  assumed  to  be  free  from  putrefying  organic  substances.  Very 
little  is  known  of  the  effects  of  ozone  on  the  system  beyond  the  fact 
that,  except  in  largely  diluted  form',  it  is  dangerously  irritating  (see 

P-  736). 

Ammonia,  as  well  as  nitrous  and  nitric  acids,  are  always  present, 
at  least  in  traces  in  the  air,  and  benefit  the  soil  through  the  rain 
which  dissolves  more  or  less  of  them. 

Coal  contains  about  8  pounds  of  sulphur  per  1,000,  which  by  com- 
bustion becomes  oxidized  into  sulphuric  acid ;  thousands  of  tons  of 
this  acid  are  every  year  showered  upon  the  eastern  United  States 
by  the  rain. 

Aqueous  vapor  is  a  constant  and  very  important  constituent  of  air, 
although  variable  in  amount  and  unequally  diffused.  It  is  derived 


512  MILITARY    HYGIENE. 

from  many  sources :  the  evaporation  of  water  and  soil,  the  evapo- 
ration from  the  skin  and  lungs  of  animals,  from  combustion  and 
from  the  transpiration  of  plants.  An  adult  man,  under  average 
conditions,  gives  off  from  3  to  4  pounds  of  watery  vapor  from  his 
skin  and  lungs,  namely,  2.^/2  pounds  from  the  skin  and  the  remainder 
from  the  lungs.  The  amount  given  off  by  animals,  however,  is  very 
small  compared  to  that  contributed  by  plants  which  absorb  water 
in  large  quantity  from  the  soil,  through  their  roots,  and  exhale  it  as 
vapor  through  the  pores  (stomata)  of  their  leaves.  According  to 
Hellriegel,  the  amount  of  water  thus  exhaled  by  plants  is  from  250 
to  400  times  the  weight  of  the  dry  wood  formed  during  the  same 
time. 

The  amount  of  invisible  vapor  which  the  air  can  hold  depends  on 
the  temperature ;  thus  the  amount  which  at  70°  F.  would  condense 
into  cloud,  fog  or  rain,  will  completely  disappear  at  90°  and  leave 
the  sky  perfectly  clear.  The  proportion  averages  about  i  per  cent., 
varying  from  less  than  o.i  to  4  per  cent.  The  air  expired  in  breath- 
ing is  saturated,  containing  about  6  per  cent,  of  moisture.  The 
capacity  of  the  air  to  hold  moisture  is  doubled  for  every  temperature 
increase  of  27°  F.  As  already  stated,  moist  air  is  lighter  than  dry 
air,  and  upon  this  largely  depends  the  motive  power  of  the  atmos- 
phere. The  air  lightened  by  heat  and  vapor  ascends  and,  on  cool- 
ing, parts  with  vapor  which  condenses  as  cloud;  this  condensation 
sets  free  the  latent  heat  of  vaporization  and  this  heat  serves  to 
carry  the  neighboring  air  to  still  loftier  altitudes  (Leonard  Hill}. 
Water  vapor  and  dust  modify  the  transparency  and  diathermancy  of 
the  air;  they  both  soften  the  scorching  power  of  the  sun  and  pre- 
vent the  rapid  scattering  into  space  of  the  heat  gained  by  the  earth, 
a  parasol  at  noon  and  a  blanket  at  night.  Water  vapor  acts  like  the 
glass  panes  of  a  greenhouse  in  absorbing  and  retaining  heat,  there- 
fore as  a  temperature  regulator;  it  is  also  a  great  reservoir  and 
carrier  of  latent  heat  which  becomes  actual  heat  when  the  vapor 
condenses. 

The  degree  of  temperature  to  which  the  air  must  be  cooled  to 
cause  condensation  of  its  vapor  is  the  "  dew  point/'  while  the  air 
which  is  so  charged  with  vapor  that  any  lowering  of  temperature 
would  produce  precipitation  is  said  to  be  "  saturated."  When  the 
air  is  saturated,  it  is  unable  to  absorb  more  vapor  and  therefore 
evaporation  from  the  skin  ceases,  but  perspiration  being  a  necessary 


AIR.  513 

function  of  life  continues,  although  very  much  diminished;  this  is 
a  very  uncomfortable  weather  condition  popularly  described  as 
"  sticky  "  in  summer  and  "  raw  "  in  winter. 

RELATIVE  HUMIDITY.  —  The  "relative  humidity"  of  the  air  is 
the  percentage  of  the  total  amount  it  can  take  up  to  become  satu- 
rated at  any  given  temperature.  It  is  obtained  by  dividing  the 
weight  of  vapor  actually  existing  in  the  air  by  the  weight  of  vapor 
which  would  be  present  if  the  air  were  saturated.  Thus  the  relative 
humidity  of  the  Eastern  States  ranges  from  60  to  75,  that  is  to  say, 
is  from  60  to  75  per  cent,  of  saturation,  and  diminishes  as  we  ad- 
vance into  the  drier  interior  States,  reaching  its  minimum  in  Arizona 
(Fort  Yuma),  where  it  averages  only  35.  It  is  42  at  Denver  and  66 
at  Los  Angeles.  In  California  it  is  exceedingly  variable,  often 
dropping  from  nearly  100  at  dawn  to  22  at  noon.  In  England  it 
averages  about  75,  being  highest  at  9  A.  M.  The  temperature  we 
actually  experience,  in  summer,  that  is,  our  subjective  sensation  of 
heat  and  cold,  is  chiefly  determined  by  the  amount  of  our  perspiration 
and  consequent  evaporation,  and  this  depends  upon  the  dryness  of  the 
air  more  than  its  temperature,  or,  in  other  words,  upon  its  relative 
humidity.  The  drier  the  air  the  more  freely  we  perspire  and  the 
more  active  is  the  evaporation  of  the  sweat  and  cooling  of  the  skin. 
Our  skin  surface,  always  excreting  sweat,  may  be  compared  to  a  wet 
bulb  thermometer,  so  that  the  reading  of  the  latter  is  an  index  to 
our  sensation  of  heat.  Thus,  while  the  mean  July  reading  of  the 
wet  bulb  thermometer  in  Boston  is  65°  F.,  and  75°  in  Savannah,  it 
may  be  only  60°  at  Yuma,  Arizona,  in  spite  of  its  much  higher, 
torrid  summer  heat;  Arizona,  therefore,  is  cooler  and  more  com- 
fortable in  hot  weather  than  the  Eastern  States,  provided  one  is 
protected  from  the  direct  sun-rays.  Dryness  of  the  air  is  also  ex- 
pressed by  the  difference  between  the  wet  and  dry  bulb  thermome- 
ters ;  this  difference  is  about  5°  or  6°  F.  in  the  Eastern  and  Southern 
States,  increases  in  the  interior  and  reaches  its  maximum  of  about 
20°  in  Arizona.  There  the  skin  is  dry  and  harsh,  the  hair  crisp,  the 
furniture  shrinks  and  falls  apart,  newspapers  are  brittle  and  pencils 
make  no  marks. 

To  determine  atmospheric  humidity  the  easiest  method  is  that  of 
the  dry  and  wet  bulb  thermometers ;  from  their  readings  and  by 
means  of  hygrometric  tables,  can  be  deduced  the  dew-point,  the 
vapor  tension  and  the  humidity,  absolute  and  relative. 


514  MILITARY    HYGIENE. 

Physiologically,  the  essential  point  is  not  the  amount  of  humidity 
present,  but  the  amount  that  can  still  be  taken  up,  that  is,  the  short- 
age from  saturation  or  "  saturation  deficit."  This  deficit  expresses 
the  evaporative  or  drying-  power  of  the  air  from  which  the  cooling 
effect  depends,  and  is  indicated  not  only  by  the  difference  between 
the  dry  and  wet  bulbs,  but  chiefly  by  the  temperature.  Thus  the 
evaporative  force  of  the  air  with  readings  of  45°  and  50°  is  much 
greater  than  .with  readings  of  30°  and  35°,  and  will  permit  the 
evaporation  of  much  more  moisture.  This  means  that,  as  the  tem- 
perature rises,  there  will  be  an  increase  of  evaporative  force,  a 
wider  separation  between  the  dry  and  wet  bulbs  and  correspondingly 
greater  cooling  effect  in  the  shade.  This  effect,  as  in  arid  regions, 
will  often  more  than  offset  increased  solar  radiation.  As  noted  by 
Macfie,  saturated  air  at  89°  F.  will  not  relieve  the  human  system  of 
its  heat  as  fast  as  produced  and  a  febrile  condition  will  develop. 
The  same  air  at  131°,  containing  the  same  amount  of  vapor,  will 
readily  dispose  of  the  heat  production  by  virtue  of  the  brisk  evap- 
oration which  it  permits. 

A  high  degree  of  humidity  in  hot  weather  not  only  checks  perspira- 
tion but  also  hinders  radiation  from  the  body.  On  the  other  hand, 
since  moist  air  is  a  better  conductor  of  heat  than  dry  air,  it  will 
increase  the  loss  of  heat  from  the  body  by  conduction.  This  loss, 
however,  is  small  compared  to  what  it  would  be  from  radiation  and 
evaporation  of  the  perspiration  in  drier  air,  so  that  much  humidity 
renders  hot  weather  decidedly  more  oppressive.  In  cold  weather 
the  blood  is  driven  from  the  skin  so  that  radiation  of  body  heat  is  not 
active ;  if  the  air  be  damp,  the  loss  of  heat  by  conduction,  especially 
if  the  wind  be  blowing,  is  greater  than  the  loss  which  would  result 
from  radiation  in  drier  air.  It  follows,  therefore,  that  humidity 
produces  opposite  effects,  intensifying  both  heat  and 'cold,  and  that 
dry  air  is  preferable  in  either  extreme  of  temperature. 

High  humidity,  in  a  cold  or  temperate  climate,  increases  the  urine 
and  intestinal  secretions,  causing  great  dilution  of  the  blood,  slower 
circulation  and  other  conditions  tending  to  develop  the  phlegmatic 
temperament.  Dry  air,  on  the  contrary,  decreases  the  liquids  of  the 
body,  quickens  the  pulse  and  stimulates  the  nervous  system,  produc- 
ing a  more  restless  and  excitable  temperament.  Dry  air  has  also  a 
marked  tonic  influence  and  is  beneficial  in  most  chronic  diseases. 
This  is  attributable,  in  part,  to  its  desiccating  and  inhibitory  effect 
upon  many  of  the  micro-organisms  which  prey  upon  the  body. 


AIR.  515 

Three  main  factors  influence  the  temperature  of  the  air :  latitude, 
altitude  and  the  proximity  of  large  bodies  of  water. 

OCEAX  AND  LAKES.  —  The  influence  of  large  bodies  of  water  on 
the  temperature  of  the  air  and  climate  is .  worth  noticing.  Water 
having  much  greater  specific  heat  than  land  is  much  more  slowly 
heated  by  solar  radiation,  but  the  heat  penetrates  deeper  and  is  not 
so  easily  parted  with.  It  follows  that  the  diurnal  and  annual  changes 
are  much  smaller  on  the  ocean  or  near  the  coast  than  in  the  interior ; 
the  range  of  temperature  is  smaller,  the  winter  milder,  the  summer 
cooler,  and  the  climate  therefore  more  equable.  This  influence  is 
also  exerted  by  great  lakes;  thus  a  difference  of  10  to  15°  F.  has 
been  noticed  between  the  northern  and  southern  shores  of  Lake 
Ontario  in  winter,  the  southern  shore  being  protected  by  the  water 
against  the  northern  wind. 

FORESTS.  —  The  influence  of  forests  upon  the  climate  is  only  local 
and  not  marked.  They  mitigate  extremes  of  temperature,  the  sum- 
mer heat  much  more  than  the  winter  cold,  and  check  the  violence  of 
the  winds.  Their  cooling  effect  in  summer  is  due  to  the  shading  of 
the  ground,  the  increased  surface  of  heat  radiation,  the  active  radiat- 
ing power  of  leaves  and  the  free  evaporation  of  the  moisture  which 
they  discharge.  There  is  no  proof  that  the  air  of  forests  is  richer 
in  oxygen  or  ozone  than  outside  air,  but  it  is  often  stimulating  from 
the  exhaled  essential  oils  it  contains. 

EFFECT  OF  ALTITUDE.  —  As  we  rise  above  sea-level,  air  pressure 
diminishes ;  at  an  altitude  of  6,000  or  7,000  feet  it  has  decreased  one- 
fourth  and  the  first  symptoms  of  "  mountain  sickness "  may  be 
noticed.  At  an  altitude  of  18,000  feet  it  has  decreased  one-half  and 
these  symptoms  become  much  aggravated ;  they  consist  in  shortness 
of  breath,  weakness,  headache,  dizziness,  nausea,  increased  pulse, 
palpitations,  quick  irregular  respiration,  nose-bleed  and  fainting 
spells.  Mountain  sickness  is  due  to  lack  of  oxygen,  produced  by 
diminished  air  pressure.  As  this  pressure  decreases,  the  force  of 
the  heart  beat  remaining  about  the  same,  there  is  a  flux  of  blood  to 
the  skin  and  mucous  membranes,  sometimes  causing  the  latter  to 
bleed;  the  pulmonary  arterioles  become  congested  and  dilated,  thus 
to  some  extent  reducing  the  respiratory  surface.  Such  mechanical 
impediment,  however,  is  probably  only  temporary  and  not  of  much 
moment.  The  illness  is  mostly  due  to  the  failure  of  the  red  blood- 
corpuscles  to  carry  enough  oxygen  to  the  tissues,  so  that  the  organs 


516  MILITARY    HYGIENE. 

are  unable  to  function  properly,  the  heart  and  brain  being  especially 
sensitive  to  this  deprivation. 

Even  in  the  rarefied  air  of  the  highest  mountains  there  would 
always  be  enough  oxygen  to  supply  the  blood  cells  and  the  needs  of 
the  tissues  were  it  not  for  the  fact  that  the  chemical  affinity  of 
oxygen  for  hemoglobin  is  influenced  by  pressure,  diminishing  as 
soon  as  the  tension  of  this  gas  in  the  alveolar  air  and  the  blood  falls 
below  a  certain  point,  causing  a  dissociation  between  hemoglobin  and 
oxygen,  which  increases  with  the  fall  of  pressure. 

Nature  endeavors  to  supply  the  deficient  oxygen  in  various  ways 
so  that  by  suitable  training  there  is  hardly  any  altitude  on  the  earth 
that  a  man  with  sound  heart  and  lungs  may  not  be  able  to  overcome. 
These  compensatory  provisions  are : 

1.  Deep  breathing,  whereby  the  alveolar  oxygen  tension  can  gen- 
erally be  maintained  near  the  normal  point.    A  superficial  breather, 
normally  inhaling  270  c.  c.  of  air  20  times  a  minute,  only  absorbs 
5.400  c.  c.,  while  another,  inhaling  440  c.  c.  14  times  a  minute,  takes 
in  6,160  c.  c.,  and  will  be  able  to  reach  a  much  higher  altitude  than 
the  former. 

2.  Slight  increase  of  pulse  rate. 

3.  Increased  activity  of  the  alveolar  epithelium  in  secreting  oxygen 
inward  into  the  arterioles;  so  that  the  tension  of  this  gas  is  soon 
much  higher  in  the  blood  than  in  the  alveolar  air. 

4.  Increase  of  the  hemoglobin  and  red  cells  of  the  blood.     This 
increase  has  long  been  noted.    Even  at  the  comparatively  small  alti- 
tude of  5,500  feet,  Jaquet  and  Suter  found  that  the  blood  of  rabbits, 
within  two  weeks,  became  greater  in  quantity  (15  per  cent.)   and 
richer  in  quality,  containing  more  red  cells  (13  per  cent.)  and  more 
hemoglobin  (9  per  cent.).     This  increase  appears  to  be  permanent 
and  is  found  in  most  highlanders. 

5.  Increased  amplitude  of  chest  and  capacity  of  lungs.    The  rela- 
tively large  chest  of  the  natives  of  the  elevated  plateaus  of  Mexico 
and  Peru  is  a  well  known  fact. 

Such  are  nature's  adjustments  for  life  in  a  rarefied  atmosphere, 
which  render  possible  the  growth  and  prosperity  of  cities  like  Mexico 
at  7,524  feet,  Quito  at  9,520,  Leadville  (Colo.)  at  10,200,  and  Fotosi 
(Bolivia)  at  13,600  feet  above  sea-level. 

If  the  change  of  altitude  is  not  too  great,  too  sudden,  or  of  too 
long  duration,  the  symptoms  are  slight  and  ephemeral,  lungs  and 


AIR.  517 

heart  soon  recovering  their  normal  condition.  But  if  the  change  is 
permanent,  some  time  is  required  for  the  system  to  accommodate 
itself  to  it.  Thus  people  going  from  the  Eastern  States  to  reside  at 
Cheyenne,  Wyo.,  or  the  neighboring  post  of  Fort  Russell,  about  6,000 
feet  high,  may  not  be  aware  of  any  difference  in  their  sensations, 
but  it  will  be  several  weeks  before  they  regain  their  full  capacity  for 
active  physical  and  mental  work.  There  is  always  danger  for  people 
with  unsound  heart  and  lungs  to  ascend  to  the  summit  of  high 
mountains  by  steam  or  electric  cars,  their  power  of  accommodation 
being  unequal  to  the  great  and 'sudden  fall  of  air  pressure.  The 
same  risk  is  incurred  by  aeronauts  and  aviators  who  rapidly  reach 
high  altitudes. 

As  one  rises  above  sea-level  the  temperature  falls,  at  the  approx- 
imate rate  of  i°  F.  for  each  300  feet.  Owing  to  the  absence  of  dust 
and  water  particles  at  high  altitudes,  as  well  as  to  the  greater  diather- 
mancy of  the  thinner  air,  the  radiant  heat  of  the  sun  is  much 
greater;  its  rays  are  more  scorching,  although  the  air  itself  may  be 
like  that  of  an  arctic  climate.  The  heat  radiation  from  the  earth  is 
also  greater,  rendering  the  nights  colder.  The  air  is  drier  and 
purer;  dead  animals  often  mummify  without  decaying;  meat  can 
be  dried  (jerked)  by  exposure  to  the  sun,  and  the  grass  is  self-cured 
on  the  plains.  Giles*  observed  that  at  an  altitude  of  16,500  feet, 
while  the  temperature  at  noon,  in  May,  stood  at  —  20°  F.,  the  sun 
thermometer  registered  165°  ;  one  side  of  the  hand  turned  to  the 
sun  would  be  scorched  while  the  other  was  chilled,  as  if  in  contact 
with  cold  water. 

The  therapeutic  value  of  mountain  air  lies  in  its  purity  from  dust 
and  bacteria,  its  bracing  cold,  intense  insolation,  greater  radio- 
activity and  in  the  increased  formation  of  hemoglobin,  resulting  in 
more  active  metabolism  and  the  strengthening  of  the  heart  and 
respiratory  mechanism. 

ATMOSPHERIC  DUST.  —  Dust  is  a  normal  and  very  important  con- 
stituent of  the  air,  being  derived  from  the  soil  by  the  action  of  the 
winds,  from  combustion,  volcanoes  and  meteorites,  while,  at  sea. 
much  salt  dust  is  shaken  off  from  the  spray  of  the  waves.  It  is  of 
organic  and  inorganic  origin,  a  certain  proportion  of  it  consisting  of 
micro-organisms  which  are  either  free  or,  more  commonly,  adherent 

*  Climate  and  Health  in  hot  countries. 


518  MILITARY    HYGIENE. 

to  mineral  particles.  Dust  is  abundant  everywhere  but  especially  in 
the  vicinity  of  towns  and  manufacturing  centers.  Smoke  consists 
chiefly  of  fine  carbon  dust;  it  has  been  estimated  that  a  puff  from 
the  cigarette  smoker  contains  4,000,000,000  particles  of  it.  The  haze 
of  summer  days  is  chiefly  the  result  of  smoke.  Much  of  the  atmos- 
pheric dust  is  readily  visible  to  the  naked  eye,  but  more  is  micro- 
scopic and  even  ultra-microscopic,  that  is  to  say,  so  extremely  tenu- 
ous as  to  be  beyond  the  power  of  the  microscope. 

The  chief  function  of  atmospheric  dust  is  to  condense  aqueous 
vapor  and  cause  precipitation,  each  particle  being  a  nucleus  upon 
which  a  minute  droplet  forms,  these  droplets  coalescing  into  drops. 
Were  it  not  for  this  dust,  there  would  be  no  cloud,  no  mist  and  no 
rain,  the  aqueous  vapor  condensing  directly  upon  the  surface  of  the 
earth,  wherever  the  air  penetrates.  "  The  inside  of  our  houses 
would  become  wet;  the  walls  and  every  object  in  the  room  would 
run  with  moisture"  (John  Altken). 

The  great  importance  of  atmospheric  dust  in  scattering  and  dif- 
fusing sunlight,  and  thus  rendering  objects  visible,  should  also  be 
mentioned. 

For  dust  in  connection  with  respiration  and  heating,  see  pages 
520  and  554. 


CHAPTER  XLII. 

VENTILATION. 

"  There  is  nothing  so  priceless  and  yet  so  costless  as  air.  There 
is  no  financial  investment  which  does  or  can  yield  3o  sure  and  so 
large  returns  as  money  wisely  expended  for  pure  air."  (Prof. 
S.  H.  Woodbridge.) 

Pure  air  is  as  necessary  as  pure  water  and  wholesome  food  for 
the  maintenance  of  health.  Its  vivifying  qualities  are  best  mani- 
fested when  unconfined,  in  the  open ;  as  soon  as  its  free  movement 
is  interfered  with,  these  qualities  are  altered.  Thus  the  compara- 
tively pure  air  of  well-ventilated  rooms  is  different  from  the  fresh 
outside  air;  the  latter  possesses  tonic  and  stimulating  properties 
which  are  lacking  in  the  former.  This  is  shown  by  the  great  success 
of  the  open-air  treatment  not  only  of  tuberculosis  but  of  all  infec- 
tious diseases,  in  winter  as  well  as  in  summer.  It  is  also  shown  by 
the  excellent  results  obtained  in  open-air  schools.  In  what  consists 
this  vivifying  principle  of  the  free  air  still  remains  one  of  the  secrets 
of  nature. 

Ventilation  may  be  defined  as  the  continuous  and  systematic  re- 
newal of  air,  so  as  to  keep  it  as  fresh  and  pure  as  possible. 

CAUSES  OF  AIR  CONTAMINATION. —  The  air  of  inhabited  buildings 
is  fouled  by  many  causes,  but  especially  by  respiration,  excretions, 
dust,  combustion  and  decomposition. 

In  the  process  of  respiration,  a  certain  amount  of  oxygen  is  ab- 
sorbed by  the  blood,  so  that  expired  air  contains  only  16.40  parts  of 
this  gas ;  the  proportion  of  nitrogen  remains  unchanged,  whereas 
carbon  dioxid  is  increased  from  0.03  to  4.40  per  cent.,  the  lungs  of 
the  average  adult  at  rest  eliminating  about  16  cubic  feet  of  it  in  the 
twenty-four  hours,  or  0.66  of  a  cubic  foot  per  hour.  Expired  air 
has  nearly  the  temperature  of  the  body  and  is  therefore  generally 
lighter  than  outside  air ;  it  is,  furthermore,  saturated  with  moisture, 
the  amount  given  off  per  man  in  a  day  being  about  a  pound. 
Whether  expired  air  contains  any  special  organic  matter,  some  vola- 
tile alkaloid,  as  described  by  Brown-Sequard,  seems  quite  doubtful, 
the  weight  of  evidence  being  against  such  assumption.  This  ques- 

519 


52O  MILITARY    HYGIENE. 

tion,  however,  was  recently  reopened  by  the  experiments  of  Rosenau 
tending  to  show  that  there  is  a  substance  in  the  condensed  moisture 
from  the  expired  breath  capable  of  sensitizing  guinea-pigs  so  that 
they  will  react  to  anaphylaxis,  that  is,  to  a  subsequent  injection  of 
normal  human  serum.  Further  investigation  will  be  required  to 
determine  the  practical  significance  of  this  phenomenon.  There  is 
general  agreement  that  expired  air  received  directly  from  the  trachea 
of  a  normal  animal  is  odorless,  as  well  as  the  liquid  obtained  from 
its  condensation  by  cold.  "  In  ordinary  quiet  respiration,  no  bac- 
teria, epithelial  scales,  or  particles  of  dead  tissue  are  contained  in 
the  expired  air.  The  cause  of  unpleasant,  musty  odors  in  rooms 
may  in  part  be  due  to  volatile  products  of  decomposition  from 
decayed  teeth,  foul  mouths,  or  disorders  of  the  digestive  apparatus, 
and  in  'part  to  volatile  fatty  acids  given  off  with  or  produced  from 
the  excretion  of  the  skin,  and  from  clothing  soiled  with  such  excre- 
tions "  (Drs.  Mitchell,  Billings  and  Bergey).  Straus  found,  in  one 
experiment,  that  although  the  inspired  air  contained  over  20,000 
bacteria,  only  40  were  present  in  the  expired  air,  and  concluded  that 
the  nasal  mucus  possesses  marked  bactericidal  properties.  Many 
germs,  however,  may  be  contained  in  the  particles  of  saliva  or 
mucous  secretions  ejected  in  coughing,  sneezing  or  even  speaking, 
sometimes  of  a  dangerous  character,  as  in  diseased  conditions  of  the 
throat,  tonsils  or  lungs. 

The  skin  contributes  materially  to  air  pollution.  It  excretes  two 
or  three  times  more  water  than  the  lungs ;  this  water,  or  sweat,  con- 
tains fatty  acids,  ammonia  and  soda  salts ;  mixed  with  the  sebaceous 
secretion,  epidermic  debris  and  dust,  it  soon  gives  rise  to  ill-smelling 
products.  The  CO2  excreted  by  the  skin  is  a  negligible  quantity. 

From  these  several  sources  are  derived  the  offensive  organic  and 
nitrogenous  matters,  either  gaseous  or  in  the  form  of  invisible  dust, 
which  contaminate  crowded  rooms,  being  slowly  oxidized  and  long 
retained  by  hygroscopic  surfaces  and  clothing. 

The  proportion  of  oxygen  is  but  slightly  affected  by  bad  ventila- 
tion, even  under  the  worst  conditions  being  seldom  more  than  I  or  2 
per  cent,  below  normal. 

DUST.  —  The  dust  which  contaminates  the  lower  air  strata  and  is 
commonly  breathed  by  man  is  a  compound  of  many  ingredients, 
mineral  and  organic,  namely :  house  and  street  sweepings ;  mud  and 
dirt  dragged  into  houses,  dried  and  pulverized;  powdered  earth, 


VENTILATION.  521 

plaster,  asphalt,  ashes,  iron  dust;  soot  from  chimneys;  garbage  fre- 
quently strewn  in  streets;  excrements  of  horses,  dogs  and  other 
animals ;  human  excrements  in  congested  tenement  districts ;  desic- 
cated sputum;  microbes  of  all  kinds,  etc.  Of  mineral  constituents, 
in  cities,  iron  and  steel  dust  deserves  special  attention ;  it  is  pro- 
duced by  elevated  railroads,  subways,  trolleys,  automobiles,  horse 
.shoes  and  the  nails  on  shoes  of  pedestrians,  and  may  amount  to 
many  tons  a  month.  According  to  Soper,  the  dust  collected  in  the 
air  of  New  York,  300  to  400  feet  above  street  level,  contains  10  to  15 
per  cent,  of  metallic  dust;  in  the  streets,  35  per  cent.,  and  in  the 
subways,  63  per  cent. 

The  dust  which  gathers  inside  houses  is  largely  made  up  of  organic 
matter,  consisting  of  vegetable  and  animal  fibers,  hairs,  epithelial 
cells,  foodstuffs,  pollen,  spores,  etc.  Micro-organisms,  pathogenic 
and  others,  are  also  abundant  in  air,  in  and  out  of  habitations,  form- 
ing the  so-called  "  microbial  dust."  They  generally  adhere  to 
mineral  or  other  particles,  and  their  viability  depends  much  upon  the 
hygroscopic  moisture  of  the  latter.  In  a  bed-room,  Miguel  found 
4,500  to  the  cubic  meter,  and  40,000  in  the  ward  of  a  hospital ;  in  a 
barrack,  at  reveille,  Kiener  and  Aldiber  counted  220,000.  The  num- 
ber found  in  any  room  varies  enormously  according  to  the  occupa- 
tion of  the  inmates,  the  agitation  of  the  air  and  the  currents  formed 
through  it ;  for  dust  settles  rapidly  on  walls,  woodwork  and  furni- 
ture in  a  quiet  atmosphere,  but  is  again  quickly  raised  and  floated 
by  air  disturbances. 

Micro-organisms  are  much  more  abundant  in  towns  than  in  the 
country,  in  the  proportion  of  nearly  10  to  i ;  thus  while  the  average 
number  in  Paris  is  3,910  to  the  cubic  meter,  that  at  Montsouris 
(just  outside  the  city)  is  only  455  (Miguel).  The  number  decreases 
with  the  altitude  and  they  soon  disappear  above  6,000  feet.  Thus 
none  are  found  on  the  summit  of  Mount  Blanc.  Sea  air,  100  miles 
from  the  coast,  is  also  entirely  free  from  them,  as  well  as  the  high 
altitudes  of  the  Arctic  Circle. 

Mineral  dust,  when  abundant,  may  produce  irritation  and  possibly 
inflammation  of  the  respiratory  passages.  By  maintaining  a  con- 
gested condition  of  the  mucosa  it  favors  the  implantation  of  patho- 
genic germs,  and  becomes  a  predisposing  cause  of  asthma,  hay  fever 
and  bronchitis.  It  is  also  a  frequent  cause  of  conjunctivitis.  The 
inhalation  of  metallic  dust  may,  in  time,  seriously  damage  the  pul- 


522  MILITARY    HYGIENE. 

monary  tissue.  Workers  in  dust-producing  industries  are  notori- 
ously liable  to  tuberculosis.  Ordinary  atmospheric  dust,  such  as  is 
produced  by  natural  agencies,  causes  wonderfully  little  irritation  of 
the  healthy  respiratory  mucosa,  being  arrested  and  disposed  of  by 
the  mucous  secretion  of  nostrils  and  tonsils  and  the  ciliated  epithe- 
lium of  the  bronchi.  Even  when  loaded  with  dust,  air  can  often  be 
breathed  for  many  days  with  surprising  immunity.  This  is  ex- 
plained by  Prof.  K.  B.  Lehmann,  who  demonstrated  that  the  great 
bulk  of  the  inspired  dust  is  caught  by  the  nasal,  oral  and  pharyngeal 
mucosa  and  swallowed,  so  that,  at  best,  less  than  a  quarter  of  it 
enters  the  bronchi.  The  soluble  dust  may  be  absorbed  along  the 
gastro-intestinal  path  and  cause  chronic  intoxications. 

The  serious  danger  from  dust,  however,  is  supposed  to  be  from 
the  more  or  less  desiccated  micro-organisms  it  carries.  From  their 
elaborate  experiments  in  connection  with  aerial  infection,  Winslow 
and  Kligler  arrived  at  the  following  findings  and  conclusions  :* 

City-street  dust  (as  determined  by  plating  on  lactose  agar  at  20° 
C.)  averages  about  50,000,000  micro-organisms  per  gram,  and  indoor 
dust  between  3  and  5  millions.  Spore-forming  aerobes  make  up 
only  i/io  or  less  of  the  total.  All  street  dust,  and  nearly  all  indoor 
dust,  show  the  colon  bacillus  in  the  ratio  to  total  count  of  I  in  963 
for  street  dust  and  i  in  3,582  for  indoor  dust,  indicating  that  the 
origin  of  this  bacillus  is  mainly  the  horse  droppings.  The  ratio  of 
acid- forming  streptococci  (of  type  characteristic  of  human  mouth 
and  intestine)  is  five  times  greater  for  indoor  than  for  outdoor  dust. 
Actual  isolations  of  non-spore-forming  bacilli  from  dust  were  con- 
fined almost  wholly  to  a  few  B.  diphtheria  and  many  of  the  tubercle 
bacilli,  as  well  as  of  streptococci  and  diplococci  more  or  less  closely 
resembling  the  pneumococcus.  All  bacilli  suffer  a  more  or  less 
rapid  reduction  in  drying.  Thus  99  per  cent,  of  the  colon  bacillus 
when  dried  in  sand  perish  in  24  hours.  Bacilli  which  are  completely 
eliminated  in  10  to  15  days  are  probably  90  per  cent,  gone  in  a  few 
hours,  therefore  making  the  danger  of  infection  negligible  long  be- 
fore the  last  have  disappeared.  The  spread  of  cholera,  plague,  influ- 
enza and  gonorrhea  by  dust  is  practically  impossible,  that  of  typhoid 
fever  and  diphtheria  is  possible  though  not  probable,  while  the 
tubercle  bacillus  and  the  pus  cocci  are  the  only  organisms  likely  to 
be  transmitted  in  that  way.  The  tubercle  bacillus  may  sometimes  be 

*Dust.     Am.  J.  of  Public  Health,  1912. 


VENTILATION.  523 

found  in  5  to  10  per  cent,  of  samples  of  indoor  dusts,  even  when  not 
especially  exposed  to  tubercular  infection,  but  such  dust  lies  inert  on 
floors  and  other  surfaces  and  can  only  be  distributed  by  more  or  less 
violent  air  agitation.  In  conclusion,  these 'observers  feel  warranted 
to  state  that,  with  the  exception  of  anthrax,  the  evidence  of  infection 
by  air  or  dust  is  practically  nil. 

According  to  Anders,  f  pus-producing  germs  are  especially  abund- 
ant in  dust  and  liable  to  cause  boils,  carbuncles  and  purulent  catarrh ; 
this  author  calls  attention  to  the  outbreaks  of  tonsillitis,  influenza 
and  bronchitis  often  associated  with  long  periods  of  dry,  gusty 
weather. 

In  cleaning  streets  care  must  be  observed  not  to  raise  dust.  The 
primitive  method  of  sweeping  them  in  the  dry  state,  with  hand 
brooms,  is  an  evidence  of  careless  ignoranc'e  now  fortunately  seldom 
seen.  The  best  method  of  cleaning  city  streets  is  undoubtedly  by 
automobile  vacuum  or  pneumatic  cleaners,  which  work  much  more 
rapidly  and  efficiently  than  horse-drawn  sweepers.  Flushing  with 
water  so  as  to  wash  all  the  dirt  and  dust  into  the  gutters  is  also  very 
satisfactory  where  the  sewerage  is  adequate.  Oiling  gives  excellent 
results  on  macadam  and  earth  roads. 

Combustion,  like  respiration,  absorbs  oxygen  and  gives  off  CO2 
and  aqueous  vapor.  Besides  raising  the  temperature  of  the  room, 
it  also  generates  various  gases  and  volatile  substances  according  to 
the  fuel  or  illuminant  used,  namely:  carbon  monoxid,  nitrous  and 
nitric  acid,  compounds  of  ammonia  and  of  sulphur,  marsh  gas  and 
fatty  acids.  An  ordinary  burner  consumes  5  cubic  feet  of  gas  per 
hour;  as  each  foot  of  gas  needs  5.33  cubic  feet  of  air'for  its  com- 
bustion, the  burner  will  therefore  require  26  feet  per  hour  or  624 
per  day.  Each  cubic  foot  of  gas  produces,  in  burning,  half  a  cubic 
foot  of  CO,,  therefore  the  burner,  in  one  hour,  will  evolve  2l/2  feet, 
or  about  4  times  as  much  as  an  adult  man.  Each  pound  of  coal  re- 
quires 300  cubic  feet  of  air  for  its  combustion,  but  most  of  the 
products  pass  up  the  chimney  and  do  not  contaminate  the  breathed 
air. 

The  atmosphere  of  manufacturing  cities  is  greatly  vitiated  by 
smoke.  It  is  estimated  that  London  is  thus  deprived  of  about  one- 
half  of  its  possible  sunlight  and  daylight  in  winter,  and  that  20  per 
cent,  of  its  notorious  fogs  are  due  to  the  same  cause.  According  to 


t/.  Am.  Med.  Ass.,  Nov.  4,  1911. 


524  MILITARY    HYGIENE. 

Prof.  C.  Roberts,  the  air  of  that  city  is  daily  tainted  with  250  tons 
of  the  gases,  acids  and  volatile  substances  enumerated  above,  as  well 
as  with  50  tons  of  soot.  In  Indianapolis,  Ind.,  Barnard  and  McAbee 
have  shown  that  at  least  1,200  tons  per  annum  of  soot  and  ash  fall 
over  an  area  of  a  square  mile  near  the  center  of  the  town.  Besides 
its  direct  baleful  effects  upon  health,  smoke  is  also  indirectly  injuri- 
ous in  causing  housekeepers  to  keep  the  doors  and  windows  closed 
to  exclude  the  all-pervading  soot,  thus  preventing  normal  ventilation. 

When  many  people  are  crowded  in  a  badly  ventilated  room,  the 
sense  of  smell  first  takes  cognizance  of  the  fouling  of  the  air,  which 
becomes  close  and  musty.  The  first  impression  on  entering  the  room 
should  be  noted,  for  the  effect  upon  the  olfactic  nerve  wears  off  in  a 
minute  or  two.  Then  certain  symptoms  manifest  themselves;  first, 
discomfort  and  oppression,  followed  by  headache,  fall  of  tempera- 
ture, perspiration,  exhaustion  and,  in  extreme  cases,  delirium  and 
death.  These  symptoms,  although  partly  due  to  the  products  of 
respiration  and  combustion,  and  to  fetid  odors,  must  be  chiefly 
ascribed  to  overheating,  high  humidity  and  air  stagnation  which 
operate  by  interfering  with  the  chief  function  of  the  skin,  namely, 
the  regulation  of  the  delicate  mechanism  of  temperature  equilibrium 
upon  which  normal  metabolism  depends.  Thus  the  recent  experi- 
ments of  Leonard  Hill,  Benedict,  Milner  and  others  prove  that,  in 
confined  air,  although  the  oxygen  pressure  is  reduced  to  16  per  cent, 
and  the  CO2  increased  to  2  or  3  per  cent,  (so  as  to  make  it  impossible 
to  light  a  match),  the  condition  of  extreme  discomfort  thus  pro- 
duced can  be  immediately  relieved  by  stirring  and  cooling  the  stag- 
nant air  with  electric  fans.  Provided  the  humidity  be  absorbed  and 
the  temperature  kept  down,  a  man  can  remain  in  a  small  air-tight 
chamber,  of  a  capacity  of  less  than  2,000  feet,  without  ventilation 
for  several  hours;  and,  with  partial  ventilation  (one-half  or  less  the 
amount  of  air  considered  necessary),  for  several  days  without  dis- 
comfort or  notable  change  in  body  metabolism.  Hough  notes  that 
in  such  confined  air,  although  the  odor  is  almost  overpowering,  the 
subject  is  unconscious  of  it.  Apparently  there  is  nothing  to  prove 
that  chemical  changes  in  respired  air,  whether  lack  of  oxygen,  in- 
crease of  CO2,  or  accumulation  of  organic  effluvia,  are  immediately 
injurious  to  the  human  organism  under  any  tolerable  condition  ol 
bad  ventilation. 

From  their  experiments,  Hill  and  others  conclude  that  the  high 


VENTILATION.  525 

death  rate  from  tuberculosis  and  other  diseases  found  among  persons 
living  in  crowded  and  unventilated  rooms,  must  be  attributed  to  air 
stagnation  under  improper  conditions  of  temperature  and  humidity, 
the  effects  of  such  conditions  being  to  lower  nervous  stimulation  and 
check  metabolism,  and,  in  the  second  place,  to  favor  the  growth  of 
disease-producing  organisms. 

This  new  view  of  air  contamination  rests  so  clearly  upon  experi- 
ments that  it  must  be  accepted  as  a  general  proposition.  It  is  not 
proved,  however,  that  chemical  changes  and  the  presence  of  impuri- 
ties in  the  air  are  entirely  free  from  ultimate  deleterious  effects  upon 
the  system  in  general  and  the  lungs  in  particular.  Such  conclusion 
would  be  unwarranted.  Nature  teaches  us  the  efficacy  and  necessity 
of  pure  air  in  our  instinctive  repugnance  for  air  contaminated  by 
human  respiration  or  the  smells  of  organic  decomposition.  The  fact 
that  we  can  get  used  to  the  vilest  stenches  shows  a  wonderful  power 
of  accommodation  but  not  their  innocuousness,  although  immediate 
effects  may  not  be  noticed.  It  is  indisputable  that  the  natural  and 
normal  proportion  of  the  air  constituents  is  best  for  man  and  should 
always  be  approximated  as  near  as  possible,  but  we  may  admit  that 
wide  fluctuations  for  short  periods  of  time  are  apparently  harmless. 

When  death  occurs  from  crowding  and  lack  of  ventilation,  as  in 
the  historic  instances  of  the  Black  Hole  of  Calcutta,*  the  prisoners 
of  Austerlitz,  the  passengers  on  the  steamer  Londonderry,  etc.,  it  is 
chiefly  the  result,  according  to  Leonard  Hill,  not  of  asphyxia  but  of 
heat  stroke,  causing  an  acute  febrile  condition  and  heart  failure. 

The  accumulation  of  carbon  dioxid  seems  to  have  very  little  part 
in  the  symptoms  produced  by  ill  ventilation.  It  is  to  be  remembered 
that  although  the  proportion  of  this  gas  in  normal  air  is  only  0.03 
per  cent.,  in  ordinary  respiration  at  rest,  it  averages  5.57,  and 
oxygen  only  14.89  per  cent.,  of  the  alveolar  air;  directly  after  mus- 
cular exercise  the  percentages  are  6.52  and  14.33,  respectively  (Cook 
and  Pembrey}.  Not  only  is  CO2  devoid  of  toxicity  but  it  possesses 
an  importance  not  generally  appreciated.  Boycott  and  Haldane  at- 
tribute the  subjective  sense  of  exhilaration  produced  by  cold  weather 
to  the  high  tension  of  CO2  in  the  alveolar  air.  Henderson  has 
shown  that  the  cessation  of  respiration  in  shock  results  from  a 

*In  June,  1756,  146  Europeans  were  shut  up  in  a  room  hardly  20  feet 
square,  with  only  two  very  small  windows ;  the  next  morning  only  23  were 
taken  out  alive. 


526  MILITARY    HYGIENE. 

diminished  amount  of  CO2  in  the-  blood  and  tissues  of  the  body. 
As  a  strong  stimulant  of  the  respiratory  center  its  administration  is 
advised  in  asphyxia  and  all  other  cases  of  suspended  animation,  to 
be  immediately  followed  by  oxygen  (if  deemed  necessary)  as  soon 
as  breathing  returns. 

Carbon  dioxid  being  a  necessary  product  of  respiration  and  com- 
bustion, and  its  presence  and  amount  easily  ascertained,  has  been 
chosen  as  the  index  of  air  pollution,  it  being  assumed  that  the  pro- 
portion of  other  contaminating  matters  rise  and  fall  with  it,  an  as- 
sumption, of  course,  only  approximately  correct.  The  value  and 
significance  of  such  an  index  vary  according  to  the  source  of  the 
CO2.  If  it  comes  chiefly  from  respiration,  it  will  indicate  the  pro- 
portion of  accompanying  excretory  substances  and  micro-organisms, 
but  if  mainly  from  combustion,  it  will  rather  indicate  the  ratio  of 
toxic  gases.  As  thus  understood,  the  permissible  amount  of  CO2  in 
air,  that  is  to  say,  the  amount  which,  with  the  corresponding  accom- 
paniment of  deleterious  substances,  has  no  appreciable  effect  upon 
health,  is  6  or  7  parts  per  10,000,  or  an  increase  of  3  or  4  parts  over 
the  normal  quantity.  Such  amount  is  not  detectible  by  smell.  Air 
containing  10  parts  begins  to  be  "  close; "  with  15  to  20  parts  it  is 
"  stagnant,"  while  with  more  than  25  parts  it  becomes  distinctly 
musty  and  oppressive.  There  are  few  schools,  factories,  barracks, 
etc.,  in  which  the  amount  of  CO2  does  not  reach  10  to  15  parts.  In 
crowded  halls  and  theatres  it  may  range  from  50  to  75  parts,  and,  if 
only  for  a  few  hours,  without  any  harm.  In  the  cars  of  trains  it 
often  amounts  to  20  or  25  parts,  the  air  of  smoking  cars  being  par- 
ticularly foul,  frequently  containing  4  to  5  times  as  much  ammonia 
as  the  outside  air  and  a  notable  amount  of  carbon  monoxid.  It  is 
prolonged  exposure  to  impure  air,  rather  than  the  degree  of  impur- 
ity, which  is  detrimental  to  health;  thus  a  constant  ratio  of  12  to  15 
parts  in  bed-rooms,  school-rooms  or  shops  will  impoverish  the  blood, 
stunt  the  growth  and  impair  the  power  of  resistance  to  disease  much 
more  certainly  than  occasional  exposures  to  air  containing  40  or  50 
parts. 

Tests  for  Carbon  Dioxid.  —  The  standard  method  of  determining 
CO2  for  sanitary  purposes  recommended  by  the  Committee  of  the 
Laboratory  Section  of  the  American  Public  Health  Association,  is 
the  time  method  of  Cohen  and  Appleyard,  which  combines  practi- 
cality and  reasonable  accuracy. 


VENTILATION. 


527 


"Standard  Method.  —  If  a  dilute  solution  of  lime  water,  slightly 
colored  with  phenolphthalein,  is  brought  in  contact  with  air  con- 
taining more  than  enough  CO2  to  combine  with  all  the  lime  present, 
the  solution  will  be  gradually  decolorized,  the  length  of  time  required 
depending  upon  the  amount  of  CO2  present.  The  quantity  of  lime 
water  and  volume  of  air  remaining  the  same,  the  rate  of  decoloriza- 
tion  varies  inversely  with  amount  of  carbon  dioxid.  The  method 
is  scientific  in  principle  because  it  recognizes  the  fact  that  the  absorp- 
tion of  CO2  by  Ca  or  Ba  hydroxid  solution  is  a  time  reaction. 

"  Collect  samples  of  air  in  one-half  liter  glass-stoppered  bottles  by 
any  of  the  methods  of  collection.  Run  in  10  c.  c.  standard  lime 
water,  replace  stopper,  and  note  time.  Shake  bottle  vigorously  with 
both  hands  until  color  disappears.  Note  time  required,  and  ascertain 
corresponding  amount  of  CO2  from  table." 

TABLE. 


Time  in  Minutes 

Time  in  Minutes 

to  Decolorize 

CO2  per 

to  Decolorize 

Solution 

10,000 

Solution 

li 

16.0 

3* 

ij 

13-8 

4 

li 

12.8 

4i 

2 

12.  0 

5 

zi 

H-5 

si 

2t 

8.6 

6i 

3i 

7-7 

7* 

CO:  per 
10,000 


6.0 
5-3 
S-i 
4.6 

4-4 
4.2 

3-5 


For  rough  work,  may  also  be  recommended  the  "  shaker  meth- 
od "  of  Wolpert  and  of  Fitz,  in  which  the  volume  of  air  that  must 
be  brought  into  contact  wTith  a  definite  quantity  of  lime  water,  in 
order  to  neutralize  all  the  lime,  is  taken  as  a  measure  of  the  CO2  in 
the  air. 

The  standard  lime  water  used  in  all  these  tests  is  prepared  as 
follows : 

"  Standard  Lime  Water.  —  To  a  litre  of  distilled  water  add  2.5 
c.  c.  of  phenolphthalein  (made  by  dissolving  0.7  grams  of  phenol- 
phthalein in  50  c.  c.  of  alcohol  and  adding  an  equal  volume  of  water). 
Stand  the  bottle  of  water  on  a  piece  of  white  paper  and  add  drop  by 
drop  saturated  lime  water  till  a  faint  color  persists  for  a  full  minute. 


528  MILITARY    HYGIENE. 

Now  add  6.3  c.  c.  of  saturated  lime  water  and  quickly  cork  the 
bottle,  or  connect  the  pipette." 

The  simplest  of  the  rough  tests,  with  plain  lime  water,  is  that  of 
A.  Wolpert,  as  modified  by  Prof.  Boom.  "  Make  a  mark  on  any 
test-tube,  say  one  inch  from  the  bottom.  Fix  the  bulb  of  an  ato- 
mizer to  a  small  glass  capillary  tube,  sufficiently  long  to  reach  to  the 
bottom  of  the  test-tube,  and  in  such  a  manner  that  a  definite  quantity 
of  air  is  forced  from  the  bulb  through  the  tube  at  each  compression. 
To  use :  Fill  the  test-tube  exactly  to  the  mark  with  a  saturated  solu- 
tion of  lime-water,  take  the  apparatus  into  the  outdoor  air  and  find 
out  how  many  compressions  of  the  bulb  are  needed,  driving  the  air 
slowly  through  the  lime-water  each  time,  to  make  the  lime-water 
just  turbid  enough  to  obscure  a  pencil-mark  on  white  paper  placed 
beneath  the  test-tube  and  viewed  from  above."*  Repeat  this  opera- 
tion in  the  room  to  be  tested  and  note  the  number  of  compressions 
required.  Assuming  that  the  outdoor  air  contains  the  normal 
amount  of  CO2,  namely,  0.03  per  cent.,  the  amount  contained  in  the 
air  of  the  room  will  be  to  this  normal  amount  as  the  number  of 
compressions  in  the  outdoor  air  is  to  the  number  in  the  room ;  for 
instance,  if  the  air  of  the  room  requires  only  one- third  the  number 
of  compressions  needed  in  the  outside  air,  the  amount  of  CO2  will 
be  three  times  greater,  or  0.09  per  cent. 

Carbon  Mono. rid  (CO).  —  By  far  the  most  toxic  of  the  gases 
liable  to  contaminate  the  air  of  inhabited  rooms  is  carbon  monoxid, 
the  more  dangerous  from  being  odorless.  It  is  chiefly  derived  from 
the  leakage  of  illuminating  gas  and  from  imperfect  combustion. 
Gas  prepared  from  bituminous  coal  contains  only  6  or  7  parts  of  CO, 
while  water  gas,  now  largely  superseding  it,  contains  about  30  parts 
and  is  therefore  much  more  poisonous.  It  is  also  freely  evolved 
from  burning  charcoal,  a  fact  taken  advantage  of  in  some  countries 
to  commit  painless  suicide.  The  smoke  of  tobacco  contains  a  rather 
large  proportion  of  CO,  two  purr's  of  it  upon  blood  being  sufficient 
to  demonstrate  the  absorption  of  the  gas,  by  the  spectroscope.  The 
leakage  of  coal  gas  into  the  ground  is  enormous,  amounting  to  at 
least  one-fifth  of  the  total  output,  and  much  of  it  may  be  aspirated 
into  houses  by  the  higher  temperature  of  indoor  air.  Less  than  i 
per  cent,  of  carbon  monoxid  in  the  air  of  inhabited  rooms  may  cause 
the  death  of  their  occupants,  owing  to  its  great  affinity  for  the  hemo- 

*A  Manual  of  Hygiene  arid  Sanitation.     Seneca  Egbert. 


VENTILATION.  529 

globin  of  the  blood  which  thus  loses  its  property  of  carrying  oxygen 
to  the  tissues  and  eliminating  carbon  dioxid.  Such  blood  acquires 
a  bright-red  color  (carmin  or  cherry-red)  easily  recognized  if  a  drop 
or  two,  diluted  with  distilled  water,  are  examined  in  a  test  tube ;  it 
is  more  pink,  less  yellow  than  normal  diluted  blood.  If  boiled  it 
yields  a  brick-red  mass,  while  normal  blood  becomes  brown-black. 

A  good  indicator  of  the  presence  of  a  poisonous  amount  of  CO  in 
any  confined  space  is  a  small  warm-blooded  animal,  such  as  a  mouse 
or  bird,  which  is  affected  by  this  gas  much  sooner  than  man. 

The  spectroscopic  test  is  the  most  reliable.  If  normal  blood, 
properly  diluted,  is  examined  with  the  spectroscope,  the  two  char- 
acteristic absorption  bands  of  oxyhemoglobin  appear  (both  on  the 
blue  side  of  the  D  line).  If  blood  which  has  been  exposed  to  air 
contaminated  with  CO  is  thus  examined,  the  same,  or  almost  iden- 
tical bands  are  present.  But  if  a  reducing  agent,  like  ammonium 
sulphide,  be  added,  the  normal  blood,  from  scarlet  becomes  purplish 
and  its  two  bands  coalesce  into  one  broad  band ;  the  contaminated 
blood,  on  the  contrary,  retains  its  cherry-red  color  and  its  two 
distinct  bands. 

The  symptoms  of  poisoning  by  CO  are  vomiting,  headache,  great 
debility,  loss  of  muscular  power,  unconsciousness,  shallow  stertorous 
breathing,  rapid  pulse  and  possibly  convulsions.  The  face  and 
hands,  at  first  cyanotic,  become  pink  in  color.  In  certain  industries 
in  which  workers  are  exposed  to  the  breathing  of  CO,  there  may  be 
chronic  poisoning  indicated  by  general  physical  failing  with  deficient 
muscular  power.  In  such  cases  nature  endeavors  to  correct  the  evil 
by  a  large  increase  of  blood  cells. 

Coal  gas  combustion  also  evolves  sulphurous  and  sulphuric  acids, 
sometimes  enough  to  produce  an  unpleasantly  irritating  and  acrid 
smell.  It  should  never  contain  more  than  20  grains  of  sulphur  in 
100  cubic  feet,  corresponding  to  0.032  of  a  cubic  foot  of  SO2. 

AIR  PURIFICATION.  —  The  means  employed  by  nature  for  the  puri- 
fication of  air  are  winds  and  storms,  oxidation,  bacterial  action,  rain 
and  vegetation. 

The  winds  keep  the  constituents  of  the  air  in  constant  agitation, 
mixing  them  thoroughly  and  maintaining  them  in  their  normal  rela- 
tive proportions ;  they  disperse  noxious  gases  and  organisms  and 
subject  them  more  completely  to  the  destructive  action  of  sunlight 
and  oxygen.  By  oxidation,  all  organic  matters  are  decomposed  and 


530  MILITARY    HYGIENE. 

transformed  into  simpler  innocuous  elements ;  these  changes  are 
materially  assisted  by  the  agency  of  bacteria.  Rain  washes  out  the 
air  and  carries  its  impurities  into  the  soil.  Vegetation,  as  already 
seen,  removes  the  excess  of  carbon  dioxid  from  the  air  and  absorbs 
from  the  soil  much  moisture  and  organic  matter. 

NATURE  OF  VENTILATION.  —  Ventilation  is  not  an  occasional  or 
intermittent  renewal  of  air;  it  is  a  continuous  process,  as  is  the 
pollution ;  it  therefore  implies  a  constant  movement  of  air  in  two 
directions,  inward  and  outward,  the  entrance  of  fresh  air  and  the 
escape  of  foul  air.  The  fresh  air,  however,  does  not  drive  out  the 
foul  air ;  it  diffuses  itself  into  the  room  and  dilutes  the  air  already 
used  so  as  to  render  it  innocuous.  Perfect  ventilation  would  be  that 
in  which  foul  air  is  at  once  removed  and  replaced  by  pure  outside 
air,  so  that  none  of  the  occupants  of  a  room  would  breathe  the  same 
air  twice ;  but  this  is  not  practicable ;  the  incoming  air  cannot  be 
kept  separate  from  the  air  already  used,  but  rapidly  diffuses  with 
it.  A  certain  proportion  of  air  will  be  inhaled  more  than  once,  and 
all  that  can  be  done  is  to  so  dilute  it  with  fresh  air  that  it  will  be 
harmless.  The  movement  of  air  in  ventilation  should  be  imper- 
ceptible and  never  amount  to  a  draft;  that  is  to  say,  it  must  not 
usually  exceed  3  feet  a  second.  Cold  and  damp  air  is  much  more 
readily  felt  and  likely  to  produce  unpleasant  currents  than  if  at  a 
temperature  of  about  50°  or  55°;  therefore  it  is  advisable,  in  cold 
weather,  to  warm  it  moderately,  thus  combining  ventilation  and 
heating.  Much  heating  of  the  incoming  air,  however,  is  highly  ob- 
jectionable as  it  robs  it  of  some  of  its  purifying  and  invigorating 
properties. 

The  experiments  above  referred  to  (page  524)  show  that  the  ob- 
ject of  ventilation  is  not  only  the  removal  of  noxious  chemical 
substances  but  also  the  maintenance  of  comfortable  atmospheric 
conditions  in  regard  to  temperature  and  humidity.  Nothing  so  far 
said  should  be  understood  as  tending  to  lessen  the  importance  of 
fresh  air.  The  beneficial  influence  of  pure  air  on  oxygen  absorption, 
pulmonary  exchange,  and  metabolism  cannot  be  questioned  or  exag- 
gerated, but  it  is  evident  that  to  produce  its  optimum  effect  it  must 
be  cool,  in  motion,  and  not  too  humid,  that  is  to  say,  in  such  con- 
dition as  to  favor  the  chief  function  of  the  skin,  namely  the  regula- 
tion of  body  temperature  upon  which  metabolism  and  vitality  largely 
depend.  The  necessity  of  admitting  an  abundance  of  pure  outside 


VENTILATION.  53! 

air  into  dwellings  remains  unchanged,  but  greater  attention  should 
be  given  to  indoor  temperature.  In  this  country,  the  chief  defect  of 
ventilation,  in  winter,  is  excessive  heat  and  the  abnormal  dryness 
which  results  therefrom. 

AMOUNT  OF  AIR  NECESSARY.  —  One  of  the  chief  practical  points 
in  ventilation  is  to  determine  the  amount  of  fresh  air  necessary  to 
keep  the  carbon  dioxid  down  to  the  permissible  limit  of  6  parts  per 
10,000,  namely  3  parts  as  normal  constituent  of  the  air  and  3  parts  as 
the  result  of  contamination.  The  amount  discharged  per  hour  by  an 
adult  male,  during  ordinary  activity,  is  practically  one  cubic  foot; 
during  repose  but  while  awake,  it  is  0.72  of  a  cubic  foot,  0.60  by 
an  adult  female  and  0.40  by  children.  During  sleep,  adult  males 
discharge  only  0.56  cubic  foot.  It  follows  that  0.60  represents  the 
maximum  amount  exhaled  by  individuals  in  a  mixed  community, 
or  by  soldiers  asleep  in  dormitories.  To  this  respiratory  average 
should  be  added  the  proportional  amount  resulting  from  combus- 
tion, as  the  index  of  contamination  by  the  various  gases  and  sub- 
stances of  combustion.  This  is  a  widely  variable  quantity  depend- 
ing upon  the  illuminants  used  and  mode  of  heating.  It  is  estimated 
that  this  additional  amount  should  be  about  one-half  that  of  respira- 
tion, probably  a  liberal  allowance,  making  in  all  0.90  of  a  cubic  foot 
(or  25  liters).  The  question  then  is  how  much  fresh  air  is  required 
to  dilute  0.90  cubic  foot  of  CO2  so  that  there  will  be  no  more  than 
3  parts  of  it  (the  permissible  ratio  of  contamination)  in  10,000  parts 
of  air.  It  reduces  itself  to  a  simple  rule  of  three :  — 

io.oooX.9O 
0.90  :x  1:3  :  10,000;    hence —  =3,000  feet.       In  terms 

3 

10,000X25 

of  the  metric  system  the  equation  would  be  -  —  =  83  cubic 

meters.  3 

It  thus  appears  that  each  person  should  receive,  per  hour,  about 
3,000  cubic  feet  of  fresh  air,  in  a  steady,  even,  continuous  manner, 
without  draft  or  perceptible  change  of  temperature.  The  larger 
the  room  the  fewer  renewals  of  air  will  be  required  in  the  same 
space  of  time  and  the  slower  the  interior  air  movement;  in  other 
words,  the  larger  the  cubic  space  allowed  to  each  occupant  the  more 
easily  can  the  necessary  amount  of  fresh  air  be  furnished  without 
draft.  Experience  shows  that  when  the  amount  of  air,  per  hour, 
introduced  into  a  room,  is  more  than  three  or  four  times  its  cubic 


532  MILITARY    HYGIENE. 

capacity,  a  current  becomes  perceptible.  It  follows,  then,  that  the 
capacity  of  said  room,  or  cubic  space  allowed  to  each  man,  should 

3000 
be  at  least  —  —  =  750  cubic  feet.     In  large  buildings,  such  as  public 

4 

halls  and  theaters,  where  the  occupants  have  only  300  cubic  feet 
per  head,  the  air  can  be  changed  ten  or  more  times  an  hour  and 
sufficient  ventilation  furnished  without  draft.  This  result,  how- 
ever, is  only  obtained  by  means  of  special  systems  of  artificial  venti- 
lation neither  practicable  nor  desirable  for  barracks. 

It  is  obvious  that  the  above  calculations  as  to  the  amount  of  air 
necessary  rest  upon  a  somewhat  arbitrary  basis  and  can  only  give 
approximate  figures.  Thus  it  has  been  contended  by  reputable  au- 
thorities that  the  permissible  limit  of  carbon  dioxid  should  be  9  parts 
per  10,000,  that  is,  6  parts  from  contamination  instead  of  3  as  as- 
sumed above.  This  would  only  require  an  hourly  supply  of  1,500 
cubic  feet  of  fresh  air.  The  consensus  of  opinion  of  most  investi- 
gators, however,  is  that  the  supply  should  never  be  less  than  2,000 
cubic  feet. 

The  floor  space  allowed  each  soldier  in  barracks  varies  too  fre- 
quently in  accordance  with  the  strength  of  companies  and  the  area 
of  available  quarters.  All  medical  officers  agree  that  it  should 
never  be  less  than  10  by  6  feet,  or  60  square  feet ;  with  a  ceiling  12 
feet  high  the  soldier  will  thus  have  a  minimum  cubic  space  of  720 
feet.  It  is  highly  desirable,  however,  to  make  the  minimum  floor 
area  80  square  feet  and  the  cubic  space  960  feet.  More  space 
should  be  provided  for  cavalry  than  for  infantry,  the  better  to  dis- 
sipate the  unavoidable  stable  odors  carried  by  the  men.  The  work- 
able basis  upon  which  to  determine  the  size  of  dormitories  should 
be  a  space  of  1,000  cubic  feet  per  man.  The  number  of  men  that 
can  be  accommodated  in  any  dormitory  having  been  determined  by 
proper  authority,  should  be  conspicuously  painted  over  the  door 
and,  except  in  emergencies,  never  exceeded. 

In  hospitals,  to  prevent  the  spread  of  disease,  not  only  is  thorough 
ventilation  necessary,  but  as  much  room  as  possible  should  be  pro- 
vided so  that  the  patients  may  be  properly  separated.  The  cubic 
space  allowed  each  patient  in  wards  should  never  be  less  than  1,600 
feet  and  should  reach  2,000  feet  whenever  practicable. 

The  ceilings  of  barracks,  in  cold  and  temperate  climates,  must 
never  be  less  than  10  nor  more  than  12  feet  high.  If  higher  than 


VENTILATION.  533 

this,  the  upper  part  of  the  room  is  difficult  to  aerate  and  to  clean ; 
the  added  space  is  of  but  little  use  for  ventilation ;  much  heat  is  lost, 
and  the  cost  of  construction  is  much  increased  without  correspond- 
ing gain.  This,  however,  does  not  apply  to  hospitals,  schools,  or 
public  halls,  etc.,  in  which  special  means  of  ventilation  are  provided. 
In  the  tropics,  also,  where  artificial  heat  is  not  necessary  and  an 
active  air  movement  is  desirable,  high  ceilings,  together  with  high 
doors  and  windows,  are  advantageous. 


CHAPTER  XLIII. 
VENTILATION  (CONTINUED). 

NATURAL  VENTILATION. 

Ventilation  is  conveniently  described  as  natural  and  artificial,  but 
both  systems  are  often  more  or  less  combined. 

Natural  ventilation  is  the  resultant  of  several  forces,  namely,  dif- 
fusion of  gases,  action  of  the  wind  and  thermal  circulation.  These 
forces  are  constant  but  quite  variable  in  degree.  All  gases  diffuse 
so  that  when  two  or  more  come  in  contact  a  homogeneous  mixture 
is  obtained  in  spite  of  the  action  of  gravity,  the  force  of  the  diffusion 
being  inversely  as  the  square  roots  of  the  density  of  the  gases.  The 
wind  acts  in  two  ways,  by  perflation  and  aspiration ;  by  perflation 
when  blowing  through  confined  spaces,  and  aspiration  when  blowing 
more  or  less  horizontally  over  the  top  of  chimneys  and  ventilating 
shafts ;  in  the  latter  action  of  the  wind  a  partial  vacuum  is  pro- 
duced and  the  air  sucked  up. 

The  movement  of  the  air  may  be  a  hardly  perceptible  breeze  or 
the  blast  of  a  storm,  but  is  seldom  if  ever  entirely  absent,  often 
having  a  velocity  of  2  or  3  feet  a  second  in  apparently  perfectly  still 
atmosphere  and  being  seldom  less  than  5  or  6  feet.  Free  perflation, 
through  doors,  windows  and  ventilators,  affords  the  best  kind  of 
ventilation  and  should  be  used  whenever  possible,  if  only  for  a  few 
moments  every  day.  Even  on  calm  days  the  air  is  thus  renewed 
many  times  an  hour.  In  barracks  or  other  buildings,  with  many 
occupants,  the  windows  should  be  opposite  each  other  so  that  the 
air  may  be  swept  through  the  rooms.  Air  thus  naturally  blown  in 
possesses  a  freshness  and  produces  a  stimulating  and  purifying  effect 
not  equalled  in  any  system  of  artificial  ventilation. 

The  chief  acting  force,  however,  in  natural  ventilation,  is  thermal 
circulation,  or  the  air  movement  resulting  from  the  difference  in 
density  between  masses  of  air  of  different  temperatures.  Heated 
air  expands  and  becomes  lighter ;  consequently  it  rises  until  reach- 
ing a  layer  of  the  same  density,  being  replaced  by  colder  and  heavier 
air  rushing  in  from  below.  The  heating  of  buildings  necessarily 
produces  a  difference  of  density  between  the  outside  and  inside  air ; 

534 


VENTILATION     (CONTINUED). 


535 


it  is  therefore  more  or  less  involved  in  ventilation  and  one  of  its 
necessary  factors.  As  air  gets  warmer  it  tends  to  rise  and  escape 
through  the  openings  in  the  upper  part  of  the  room  or  the  ventilat- 
ing shafts;  to  fill  the  vacuum  thus  made,  the  colder  air  pours  in 
from  the  outside  through  the  lower  openings.  If  a  vertical  slit  be 
cut  in  the  wall  of  a  room,  or  one  of  the  lateral  sashes  of  a  French 
window  opened,  it  will  be  noticed  that  the  direction  of  the  current 
through  the  lower  part  of  the  opening  is  inward  while  that  through 
the  upper  part  is  outward.  Between  the  two  currents 
is  a  neutral  zone  where  the  air  is  not  displaced.  The 
further  above  this  zone  is  an  opening  made,  the  greater 
will  be  the  difference  of  density  and  the  more  active 
the  outward  current  of  air  through  it.  It  follows 
that,  for  the  proper  ventilation  of  a  room,  at  least 
two  openings  are  needed,  preferably  at  different  levels, 
one  for  the  incoming  and  the  other  for  the  outgoing 
air.  With  only  one  opening,  unless  it  be  reasonably 
large,  the  two  currents  will  oppose  each  other,  with 
much  friction  and  loss  of  efficiency.  Thus,  if  a  lighted 
candle  be  placed  in  an  open  2-quart  bottle,  it  will 
speedily  die  out,  whereas  if  the  stopper  be  pierced 
with  two  holes  and  glass  tubes  of  unequal  length 
placed  in  them,  although  their  combined  areas  are  less 
than  the  area  of  the  open  mouth,  the  candle  will  con- 
tinue to  burn,  the  inward  and  outward  currents  pass- 
ing through  the  separate  tubes  without  interference 
(Fig.  148). 

In  an  inhabited  room,  the  air  in  contact  with  the  bodies  of  the 
occupants  becomes  warmer;  it  mixes  with  the  expired  air  which 
has  a  temperature  of  about  97°  F.  and  together  rise  in  slow  but 
steady  waves  toward  the  ceiling.  Although  expired  air  contains  a 
large  proportion  of  CO2,  it  is  so  rarefied  that  it  weighs  only  1.12 
grams  per  liter,  whereas  ordinary  air  at  62°  weighs  1.22  grams.  It 
is  a  law  that,  within  a  limited  space,  gases  which  have  no  chemical 
action  upon  one  another  are  uniformly  diffused,  independently  of 
their  respective  density.  The  CO2,  therefore,  although  heavier  than 
air,  remains  diffused  mostly  in  the  upper  layers  of  the  air  and,  with 
good  ventilation,  should  escape  before  it  can  vitiate  the  lower  layers. 
This  ascensional  movement  of  air  which  has  been  used  and  polluted, 


FIG.  148  — 
Show  ing 
the  neces- 
sity of  two 
c  u  r  r  e  n  ts 
to  sustain 
combus- 
tion. 
(Munson. 


536  MILITARY    HYGIENE. 

is  nature's  way  to  remove  it  as  soon  and  as  completely  as  possible. 
The  incoming  fresh  air  which  replaces  it  should  follow  the  same 
upward  direction.  Therefore,  air  inlets,  in  natural  ventilation,  are 
near  the  floor,  or  at  least  lower  than  the  outlets,  and  the  outlets  near 
the  ceilings.  Downward  currents  are  prevented  by  insuring  a  suffi- 
cient velocity  to  the  streams  of  vitiated  air  escaping  into  the  atmos- 
phere and  by  protecting  the  tops  of  ventilating  shafts  from  the  per- 
turbing action  of  winds.  , 

It  is  a  general  rule  that  the  air  movement  upon  which  natural 
ventilation  depends  is  upward,  but  conditions  may  exist,  especially 
in  hot  countries,  when  the  movement  is  temporarily  reversed.  Thus 
with  an  external  temperature  in  the  shade  of  90°  or  above,  it  may 
happen  that  the  interior  of  a  house  will  be  a  few  degrees  lower, 
according  to  the  amount  of  solar  radiation  excluded  by  the  roofs 
and  walls.  The  colder  and  denser  interior  air  settles  downward 
and  escapes  through  the  lower  openings,,  being  replaced  by  the  out- 
side air  rushing  in  from  above,  through  outlets,  chimneys,  ventilat- 
ing pipes  and  shafts.  This  reversed  circulation  may  have  no  un- 
pleasant result,  the  inflowing  and  diffusion  of  air  being  sufficiently 
active  for  the  needs  of  the  inmates,  but,  as  the  difference  in  tem- 
perature is  seldom  marked,  the  air  movement  is  correspondingly 
sluggish  ;  it  is  promoted  by  opening  the  lower  sash  of  windows.  Its 
effect  upon  the  main  vent  pipe  of  the  house  plumbing  will  depend 
chiefly  upon  the  nature  and  location  of  its  intercepting  trap  (Fig. 
164).  If  this  opens  outside  the  building  no  harm  will  result.  In 
warm  countries  it  is  best  to  have  the  fresh-air  pipe  of  the  inter- 
cepting trap  not  only  opening  outside,  but  at  least  7  or  8  feet  from 
the  ground,  that  is, -above  man's  breathing  line. 

The  forces  of  diffusion  and  perflation  act  not  only  through  the 
openings  especially  provided,  but  also  through  all  joints  and  inter- 
stices, and  even  through  the  walls  and  floors,  their  action  depending 
much  upon  the  porosity  of  the  materials  used  and  mode  of  con> 
struction. 

This  filtering  in  of  air,  however,  as  shown  by  Recknagel,  is  too 
small  to  be  of  much  value  as  a  ventilating  factor,  although  often 
sufficient  for  the  production  of  unpleasant  cold  drafts.  Good  sani- 
tary construction  requires  that  a  house  should  be  as  impermeable  to 
air  as  possible. 

For  the  admission  of  fresh  air,  inlets  through  the  walls  are  used ; 


VENTILATION    (CONTINUED). 


537 


they  will  be  further  considered  under  artificial  ventilation.  Various 
devices  are  also  resorted  to.  The  simplest  and  commonest  is  to 
open  the  lower  and  upper  sashes  of  a  window,  or  either  of  them. 
To  prevent  draft  the  lower  sash  may  be  raised  and  a  board  fitted 
in  the  opening;  then  the  air  inlet  is  at  the  broken  junction  of  the 
two  sashes.  Another  device  consists  in  setting  a  glass  plate,  or  glass 
frame,  vertically  or  slightly  slanting  inward,  on  the  window  sill,  a 
couple  of  inches  inside  the  lower  sash,  so  that  when  the  latter  is 
raised,  the  stream  of  air,  striking  the  plate,  is  diverted  upward. 


OUTSIDE  VIEW.  INSIDE  VIEW. 

FIG.  149. —  Ventilating  panels.     (Mobile  and  Victor  system.} 

A  method  of  natural  ventilation  now  coming  into  pretty  general 
use  is  the  insertion  of  ventilating  panels  in  windows,  below  and 
above,  the  sashes  being  raised  or  lowered  for  the  purpose.  The 
lower  panel  contains  one  or  two  boxed  inlets  through  which  the  ad- 
mission of  air  is  regulated  by  a  valve  and  the  air  itself  filtered  and 
diffused  upward;  the  upper  panel  contains  the  outlets  (Fig.  149). 
This  method  is  specially  valuable  in  winter.  French  windows  are 


538 


MILITARY    HYGIENE. 


frequently  constructed  with  a  transom  above,  hinged  outward  for 
the  escape  of  air,  thus  permitting  a  certain  degree  of  ventilation 
without  opening  the  sashes.  The  outlets  may  also  be  simple  valvu- 
lar openings  through  the  walls,  or  they  may  be  connected  with 
regular  ventilating  shafts ;  these  shafts  are  often  heated  above,  or 
contiguous  to  heating  or  smoke  flues  so  as  to  accelerate  their  ascend- 
ing current. 

A  method  of  natural  ventilation  formerly 
common  in  our  barracks  and  still  advan- 
tageously used  in  the  tropics,  is  ridge  ventila- 
tion, the  outlet  consisting  of  an  opening  ex- 
tending along  the  apex  of  the  roof,  protected 
by  a  screened  hood  against  rain,  flies  and 
mosquitoes  (Figs.  241,  242).  With  this  sys- 
tem, i -story  barracks  may  be  left  unceiled  for 
more  perfect  ventilation,  but  when  2-storied, 

ventilating  shafts  are  used  and  made  to  open 
150.— Rotating  .  ° 

exhaust        ventilator.  m  the  ridge  under  the  hood. 
(Munson.)  j-n   temporary  barracks,   or  other  buildings 

heated  by  stoves,  ventilation  is  rendered  easy 

by  bringing  fresh  air  in  conduits  to  the  jacketed  stoves  and  pro- 
viding for  the  escape  of  foul  air  by  ventilating  shafts  through  which 
pass  the  smoke-stacks  (Fig.  154). 


FIG.  151. —  Rotating  ball-bearing  Ariel  ventilator. 


VENTILATION     (CONTINUED).  539 

Chimneys,  with  or  without  lire,  have  a  marked  effect  upon  venti- 
lation, causing  an  upward  draft  which  increases  proportionately 
with  the  difference  between  the  temperature  of  the  inside  and  out- 
side air.  Thus  Morin  found  that  even  without  fire,  but  with  a  dif- 
ference of  temperature  of  21°  F.,  the  chimney  of  his  study  evac- 
uated 400  cubic  meters  of  air  per  hour.  This  strong  draft  of  chim- 
neys is  far  from  being  always  beneficial ;  it  may  produce  objection- 
able currents  along  the  floor  and  draw  down  the  foul  air  from  above. 
Chimneys  should  preferably  have  a  separate  supply  of  air  from  the 
outside,  to  be  regulated  as  desired  (Fig.  153),  while  the  up-draft 
created  by  the  fire  can  be  utilized  by  placing  a  mica  flap-valve  in 
the  flue  just  below  the  ceiling  as  an  outlet  for  foul  air. 

The  wind  blowing  horizontally  upon  or  at  right  angle  to  the  mouth 
of  a  chimney  or  ventilating  shaft  causes  a  marked  movement  of 
aspiration  up  the  flue  or  shaft,  thus  increasing  its  draft.  The  wind, 
however,  is  subject  to  so  many  disturbances  in  force  and  direction 
that  it  may  also  drive  the  air  down  and  reverse  the  current.  This 
is  prevented  by  various  cowls  and  ventilators  so  constructed  that 
from  whatever  direction  the  wind  blows  and  at  whatever  angle,  it 
passes  over  the  opening  nearly  horizontally,  thus  assisting  the  up- 
ward draft ;  besides,  they  protect  the  flue  against  rain  and  snow. 

Fig  150  shows  the  ordinary  funnel-shaped 
ventilator  revolving  so  as  to  always  present 
the  mouth  of  the  funnel  to  the  wind.  Like- 
wise revolving  is  the  Ariel  ventilator  (Fig. 
151)  in  which  the  wind  is  deflected  over  the 
mouth  of  the  chimney  so  as  to  be  always 
transformed  into  a  horizontal  draft.  Fig.  152 

shows  a  fixed  ventilator  largely  used  in  the 
FIG.  152. —  Star  fixed  .  r    ,  .  ,    u        .     .         T 

ventilator.  construction    of    barracks    and    hospitals.     In 

this  type  the  wind  is  given  an  upward  direc- 
tion by  numerous  slanting  pipes.  The  "Anchor  "  ventilator  is  of 
the  same  fixed  and  efficient  type. 

ARTIFICIAL  VENTILATION. 

Artificial  or  mechanical  ventilation  is  obtained  either  by  the  direct 
propulsion  of  fresh  air.  through  blowers  or  fans,  into  the  building 
to  be  ventilated,  the  vitiated  air  being  forced  out  by  displacement 
(plenum  system),  or  else  by  the  aspiration  of  the  vitiated  air  out 


54O  MILITARY    HYGIENE. 

of  it  (vacuum  system),  both  systems  being  generally  combined. 
The  plenum  system  is  often  used  in  large  public  buildings,  includ- 
ing hospitals.  The  process,  briefly,  is  as  follows:  The  air  taken 
from  a  pure  source  is  drawn,  through  filtering  bags,  to  the  fan  in 
the  basement,  then  forced  into  the  heating  chamber,  where  it  comes 
in  contact  with  steam  coils  and  acquires  the  degree  of  heat  desired, 
and  thence  distributed  throughout  the  building.  From  the  indi- 
vidual rooms,  in  which  it  diffuses  itself,  the  air  passes  through  the 
outlets  into  ducts  which  convey  it  to  a  central  exhaust  or  extract- 
ing flue.  In  the  vacuum  or  extraction  system  a  strong  up-draft  is 
produced  in  the  central  flue  by  means  of  steam  coils  (acceleration 
coils)  or  an  exhaust  fan,  or  both.  This  system  is  rarely  used  alone 
as  it  causes  fresh  air  to  rush  in  from  all  sides  below,  sometimes  from 
undesirable  sources,  and  numerous  drafts. 

Artificial  ventilation  has  decided  advantages:  It  is  more  or  less 
under  control  in  all  weathers ;  the  air  can  always  be  drawn  from  a 
pure  source,  filtered  and  freed  from  dust,  heated,  cooled  and  moist- 
ened as  desired.  Against  it  may  be  objected  the  difficulty  of  regu- 
lating its  mechanism  so  as  to  obtain  satisfactory  results  under  all 
conditions,  and  the  deterioration  of  the  air  as  it  passes  from  the 
fan,  through  the  heating  chamber  and  the  extended  ducts,  to  all 
parts  of  the  building.  These  objections  are  serious  and  have  caused 
the  abandonment  of  this  system  of  ventilation  in  many  buildings 
where  it  had  been  established  at  great  cost.  The  necessity  of  pre- 
serving to  the  air  the  invaluable  qualities  of  freshness  and  sweet- 
ness, to  which  its  invigorating  and  vivifying  properties  are  due, 
having  become  more  fully  realized,  the  present  tendency  of  sanitary 
engineers  is  to  rely  more  than  formerly  upon  natural  ventilation 
and  to  utilize  it  as  far  as  possible. 

For  purposes  of  ventilation  and  heating,  two  kinds  of  openings 
are  provided,  inlets  for  fresh  air  and  outlets  for  foul  air.  Since 
the  air  entering  through  the  inlets  mostly  escapes  through  the  out- 
lets,  it  follows  that,  from  the  position  of  these  openings  will  depend 
the  direction  of  the  movement  of  air,  whether  it  will  ascend,  as  in 
natural  ventilation,  or  descend  before  escaping.  Both  upward  and 
downward  systems  have  their  advocates;  their  relative  merits  may 
be  thus  summed  up.  Downward,  or  inverted,  ventilation  prevents 
the  dust  on  the  floor  from  rising  and  being  breathed  by  the  occu- 
pants; it  produces  a  more  thorough  diffusion  of  the  air  with  less 


VENTILATION     (CONTINUED).  541 

danger  of  drafts.  But,  on  the  other  hand,  having  to  overcome  the 
ascensional  currents  from  the  human  bodies,  as  well  as  from  all  gas 
flames  used  for  lighting1,  the  quantity  of  air  needed,  and  the  power 
to  extract  it,  are  enormously  greater  than  in  the  upward  system,  with 
proportionately  increased  cost.  Furthermore,  in  large  halls  with 
galleries  and  amphitheaters,  it  is  impossible  to  draw  the  air  down- 
ward without  exposing  the  people  in  the  lower  seats  to  breathe  the 
foul  air  descending  from  the  upper  tiers.  It  is  also  necessary  for  the 
successful  operation  of  this  system  to  keep  the  windows  carefully 
closed,  so  that  no  supplemental  fresh  air  can  be  directly  admitted. 
As  a  general  rule,  therefore,  and  unless  there  is  some  special  indica- 
tion to  the  contrary,  the  natural  upward  system  is  to  be  preferred. 
The  objections  against  it,  namely  dust  and  drafts,  are  readily  ob- 
viated by  the  use  of  rugs  frequently  shaken  or  of  some  adhesive 
floor  dressing,  and  by  the  proper  location  and  size  of  inlets.  It  is 
the  system  used  in  the  Capitol,  Washington,  and  the  Houses  of 
Parliament,  London. 

The  position  and  size  of  inlets  and  outlets  will  be  determined  by 
the  following  considerations.  The  inlet  registers  should  admit  the 
requisite  amount  of  air  without  currents  of  such  velocity  as  would 
cause  discomfort  to  the  occupants.  The  larger  the  area  of  register 
openings,  per  person,  the  slower  will  be  the  movement  of  air  passing 
through  them.  This  area  will  therefore  vary  according  to  the  loca- 
tion of  the  registers ;  for  instance,  if,  in  an  assembly  room,  the  fresh 
air  is  introduced  through  the  floor,  the  inlet  area  for  each  occupant 
should  be  at  least  100  square  inches,  to  prevent  drafts,  while  it  need 
not  be  more  than  30  square  inches  if  the  registers  are  placed  near  the 
ceiling  and  a  fan  is  used  to  ensure  the  requisite  increased  velocity. 
A  good  practical  rule  is  to  give  each  person  no  less  than  30  square 
inches;  this,  with  a  velocity  of  2  feet  a  second,  will  deliver  1,500 
cubic  feet  per  hour.  In  most  buildings,  however,  and  always  in 
our  military  barracks  and  hospitals,  artificial  ventilation  is  never  ex- 
clusively relied  upon  but  is  largely  supplemented  by  natural  venti- 
lation. A  better  distribution  of  air  is  obtained  by  providing  smaller 
but  more  numerous  inlets  rather  than  larger  and  fewer  openings. 

Cold,  raw  air  is  liable  to  produce  unpleasant  drafts  and  it  is  al- 
ways advisable,  in  artificial  ventilation,  to  warm  it  before  admission 
to  occupied  rooms.  This  warming,  however,  must  be  moderate, 
never  exceeding  55°  or  60°  F.,  so  as  not  to  deprive  it  of  the  fresh- 


542  MILITARY    HYGIENE. 

ness  and  invigorating  qualities  which  are  so  readily  affected  by  a 
higher  temperature.  Therefore,  air  admitted  for  ventilating  pur- 
poses should  not  be  depended  upon  for  warming  the  building  as, 
for  instance,  in  that  most  objectionable  method  of  heating,  the  hot- 
air  furnace. 

The  incoming  fresh  air,  to  be  most  available,  must  diffuse  itself 
thoroughly  in  the  room  so  that  it  may  be  breathed  by  the  occupants 
before  it  escapes.  Inlets  and  outlets  should  therefore  be  as  far 
apart  as  possible,  or  at  least  so  situated  that  the  entering  air  does 
not  pass  out  through  the  outlets  before  it  has  served  its  purpose. 
Thus  when  the  fresh  air  is  warmed,  the  inlet  registers  should  never 
be  placed  directly  below  the  foul-air  registers,  for  direct  currents 
would  easily  be  established  between  them,  with  little  effect  upon  the 
mass  of  air  in  the  room.  The  inlets  may  be  near  the  base  of  one 
wall  and  the  outlets  near  the  base  of  the  opposite  wall,  the  air 
becoming  diffused  while  passing  from  one  side  to  the  other.  If 
both  inlets  and  outlets  are  in  the  same  wall,  the  latter  should  be 
below  the  former ;  in  such  case  a  circulation  is  established  from  the 
inlets  upward  along  the  ceiling  and  across  the  room  to  the  opposite 
wall,  thence  down  to  and  along  the  floor  to  the  outlets. 

In  our  barracks  and  hospital  wards  the  fresh  air  is  generally 
introduced  by  valvular  openings  through  the  walls  directly  under 
the  radiators  (direct-indirect  system),  while  the  foul  air  escapes 
through  outlets  in  the  inside  wall. 

Whenever  the  air  is  warmed,  inlet  registers,  especially  if  suffi- 
ciently large,  may  be  near  the  floor  without  fear  of  draft ;  but,  with 
cold  air,  they  should  be  above  the  heads  of  the  occupants  (winter 
or  summer),  that  is  to  say,  about  six  feet  high  and  so  shaped  as  to 
deliver  the  air  in  an  upward  direction.  Very  often  two  outlets  are 
placed  on  the  same  shaft  in  a  room,  one  below  for  winter  use  and 
the  other  above,  near  the  ceiling,  for  the  natural  ventilation  of  sum- 
mer. Fresh-air  registers,  if  placed  on  the  floor  should  not  be  flush 
with  its  surface,  for  dust  and  dirt  will  fall  into  the  flues  and  be 
more  or  less  returned  with  the  ascending  air.  It  is  also  necessary 
that  each  room  should  have  its  own  fresh-air  flue  separate  from  all 
other  flues ;  thus  two  or  more  rooms,  one  above  the  other,  should 
never  be  supplied  from  one  common  flue. 

Conclusions.  —  The  opinion  is  growing  among  sanitarians  that 
the  plenum  system,  alone  or  in  connection  with  the  vacuum  system, 


VKNTILATION     (CONTIXUKO  )  .  543 

is  not  satisfactory,  especially  for  schools  and  hospitals.  It  is  be- 
coming generally  admitted  that  ventilation  and  heating  should  be 
made  as  independent  of  each  other  as  practicable,  so  that  the  in- 
vigorating qualities  of  the  air  may  not  be  weakened  by  exposure 
to  a  high  degree  of  heat.  This  is  made  possible  by  the  direct  sys- 
tem of  heating  which  permits  the  use  of  windows  and  transoms  for 
natural  perflation,  or  the  use  of  a  fan  to  drive  air  through  registers 
at  a  temperature  not  exceeding  50°  F.,  while  a  proper  circulation 
is  maintained  by  a  sufficient  number  of  outlets  and  shafts. 

DRAFT.  —  What  is  generally  called  a  draft  in  a  house  is  an  air 
current  colder  than  the  air  surrounding  the  body ;  therefore  it  is  not 
felt  in  the  open,  where  the  temperature  of  the  air,  whether  still  or 
in  movement,  is  everywhere  practically  the  same.  A  draft  is  most 
likely  to  be  felt  when  sitting  indoor  and  remaining  for  some  time 
in  the  same  position,  the  current  striking  only  a  limited  part  of  the 
body.  When  the  wind  blows  over  the  entire  body  the  vascular  sys- 
tem of  the  skin  contracts  to  the  extent  necessary  to  prevent  too  much 
loss  of  heat  by  radiation.  But  when  a  draft  impinges  upon  a  small 
area  of  skin,  the  vascular  system  is  unable  to  adjust  itself  to  such 
fractional  requirement,  and  much  heat  may  be  lost  from  the  part 
affected ;  it  becomes  cooler  than  the  rest  of  the  body,  with  depres- 
sion of  its  nerve  supply  and,  perhaps,  chemical  changes,  a  condition 
which  may  react  upon  some  of  the  sensitive  organs.  With  the  body 
heated  and  perspiring,  a  strong  draft  may  cause  rapid  and  energetic 
contraction  of  the  superficial  blood-vessels  and  dangerous  conges- 
tion of  internal  organs.  Windows  being  generally  colder  than  the 
walls  of  a  room  chill  the  air  in  contact  with  them,  with  production 
of  a  cold  downward  current ;  therefore  the  near  vicinity  of  windows 
is  to  be  avoided  by  persons  sensitive  to  drafts,  especially  in  winter. 


CHAPTER    XLIV. 
HEATING. 

Heat,  whether  evolved  from  the  combustion  of  fuel  or  from  any 
other  source,  is  transmitted  by  conduction,,  radiation  and  convection : 

By  conduction  when  it  passes  from  one  particle  of  matter  to  an- 
other in  contact  with  it  as,  for  instance,  in  a  poker  one  end  of  which 
is  in  the  fire.  Substances  vary  much  in  their  conductive  power; 
metals  are  much  better  conductors  than  wood,  stone  or-  glass. 
Liquids  and  gases  are  poor  conductors  but  heat  passes  readily  from 
them  to  solids,  and  conversely.  All  textile  fabrics  containing  much 
air,  such  as  furs  and  flannels,  have  likewise  a  low  degree  of  con- 
ductivity. The  following  common  substances  are  placed  in  order 
of  their  conductive  power :  copper,  iron,  lead,  slate,  glass,  water, 
brick,  asphalt,  wood,  wool,  air,  asbestos.  Conduction  plays  a  part, 
more  or  less  important,  in  all  methods  of  heating. 

By  radiation  when  it  reaches  bodies  directly  exposed  to  it  through 
the  intervening  air,  like  the  solar  heat  or  that  emanating  from  an 
open  fire.  It  is  propagated  in  straight  lines  in  all  directions  with 
equal  intensity,  the  effect  lessening  according  to  the  square  of  the 
distance.  The  air,  especially  if  dry,  is  but  little  affected  by  these 
radiant  rays;  the  objects  which  they  reach  absorb  and  reflect  them 
and,  in  their  turn,  disseminate  the  heat  by  conduction  and  convection. 

By  convection  when,  in  liquids  and  gases,  it  propagates  itself 
through  the  mobility  of  their  molecules,  those  in  direct  contact  with 
the  source  of  heat  becoming  expanded,  therefore  lighter  and  rising 
up,  while  others  descend  to  take  their  place,  so  that  ascending  and 
descending  currents  continue  until  the  whole  mass  of  liquid  or  gas 
is  evenly  heated.  Convection  plays  the  chief  part  in  the  distribution 
and  equalization  of  heat  in  an  apartment.  All  sources  of  heat  as 
well  as  heated  objects  in  it,  warm  the  air  in  immediate  contact  with 
them  and  thus  establish  convection  currents,  the  air  remaining  in 
active  movement  until  complete  diffusion  and  an  even  temperature 
are  obtained.  In  an  inhabited  room,  each  person  is  the  source  of 
a  convection  current,  the  heated  vitiated  air  rising  from  the  body, 
to  be  replaced  by  cooler  and  purer  air. 

544 


HEATING.  545 

SUITABLE   INDOOR  TEMPERATURE  AND   HUMIDITY. 

In  winter,  the  temperature  most  suitable  for  living  rooms  is  68° 
to  70°  F.,  and  for  bed-rooms  not  over  65°.  In  barracks,  factories, 
schools,  churches,  or  wherever  many  people  assemble,  it  should 
range  from  65  to  68°,  while  in  gymnasiums,  drill  halls,  etc.,  where 
active  exercise  is  taken,  it  must  not  exceed  55°.  Whenever,  in  win- 
ter, any  part  of  a  barrack  is  vacated  for  meal,  drill  or  any  other 
purpose,  the  windows  should  be  opened  so  that  it  may  be  "  blown 
out"  and  its  temperature  lowered  to  50  or  55°;  upon  the  return 
of  the  men  the  closing  of  the  windows  will  soon  raise  it  again  to 
the  proper  degree.  In  summer,  a  natural  temperature  of  65°  is 
quite  comfortable.  In  England,  the  winter  temperature  recom- 
mended for  houses  is  from  62°  to  65°,  a  difference  mostly  due  to 
the  greater  amount  of  moisture  in  the  British  Isles. 

The  thermometer  used  to  determine  the  temperature  of  a  room 
should  be  suspended  at  a  height  of  about  5  feet  on  the  inside  wall, 
but  not  in  contact  with  it,  a  space  of  3  or  4  inches  being  left  between 
so  that  the  temperature  recorded  will  be  really  that  of  the  ambiant 
air  and  not  of  the  wall.  It  should  also  be  as  far  as  possible  from 
the  source  of  heat. 

As  the  air  of  a  room  becomes  heated,  its  capacity  to  hold  moisture 
is  greatly  increased  and  its  relative  humidity  accordingly  diminished  ; 
in  other  words,  it  becomes  drier.  Thus  if  saturated  air  at  zero  be 
heated  to  80°,  its  humidity  is  reduced  to  less  than  5  per  cent.,  and 
such  air  becomes  intolerably  dry.  If  no  moisture  is  added  by 
artificial  means  it  will  absorb  it  from  the  persons,  furniture  and  all 
objects  in  the  room ;  from  the  skin,  which  becomes  hard  and  rough ; 
from  the  mucous  membranes  of  the  mouth,  nose  and  bronchi,  caus- 
ing irritation  and  cough ;  and  from  plants  which  may  wither  and  die. 
The  drying  up  of  the  mucous  membrane  of  the  respiratory  passages 
predisposes  to  infectious  diseases  by  weakening  its  bactericidal 
properties.  The  necessary  humidity,  therefore,  must  be  furnished 
so  that  it  may  not  fall  too  far  below  that  of  the  outside  air.  In  the 
eastern  and  middle  States  the  relative  humidity  of  the  air  is  from 
65  to  70  per  cent.  In  England  it  is  about  75 ;  in  Germany,  from 
50  to  60,  and  in  our  arid  western  territories,  40  to  50.  The  relative 
humidity  of  rooms  artificially  heated,  in  this  country,  is  seldom  more 
than  30  to  40.  This  should  be  brought  up  to  at  least  50  for  the 
requirements  of  the  healthy  body.  The  nearer  it  is  to  the  degree 


546  MILITARY    HYGIENE. 

of  moisture  of  the  outside  air  the  more  pleasant  it  will  feel  and 
the  lower  the  degree  of  heat  which  will  be  necessary;  thus  Dr. 
Barnes,  of  Boston,  while  keeping  his  office  at  53  per  cent,  relative 
humidity  (by  the  use  of  a  cotton  wicking  "humidifier"),  found  a 
temperature  of  65°  F.  to  be  perfectly  comfortable  instead  of  70°  as 
before  required  (Harrington).  This  is  due  to  the  fact  that  dried 
air  excites  more  active  evaporation  of  the  perspiration  and  causes 
greater  loss  of  body  heat  which  must  be  made  up  by  a  higher  air 
temperature.  It  is  therefore  quite  evident  that  a  proper  degree  of 
humidity  in  heated  rooms  is  economical  of  fuel  as  well  as  beneficial 
to  health. 

The  temperature  of  the  room  being  at  70°,  a  wet-bulb  temperature 
of  58°  (a  difference  of  12°)  would  correspond  to  50  per  cent,  of 
relative  humidity;  while  a  wet-bulb  temperature  of  62°  (a  difference 
of  8°)  would  indicate  a  relative  humidity  of  60  per  cent.  As  the 
proper  degree  of  humidity,  with  artificial  heat,  is  about  55°,  it  fol- 
lows that  in  a  room  heated  to  70°  the  difference  between  dry  and 
wet-bulb  thermometers  should  never  be  much  over  8°  (see  chapter 
on  Air). 

The  humidifiers  used  to  impart  moisture  to  the  air  are  classed 
into  the  spray  and  evaporative  types.  In  the  so-called  indirect 
evaporative  humidifier,  generally  preferred,  the  air,  taken  from  the 
outside,  is  humidified  and  conditioned  before  being  introduced  into 
the  rooms.  Humidifiers  have  also  a  distinct  value  in  their  possession 
of  a  marked  cooling  effect  in  warm  weather.  On  a  smaller  scale, 
moisture  is  imparted  to  the  air  by  placing  pans  of  water,  cotton  wick- 
ing  dipping  in  water,  or  moist  towels,  in  heated  currents  or  over 
stoves  or  radiators.  Various  special  appliances,  more  or  less  satis- 
factory, have  been  devised  for  the  purpose.  The  use  of  steam  is 
not  to  be  recommended  as  a  rule ;  it  raises  the  temperature  of  the 
air,  often  imparts  a  noticeable  odor  and  is  difficult  to  regulate. 

Houses,  barracks  and  hospitals,  as  well  as  all  other  buildings,  may 
be  heated  by  open  fire  or  grate,  stove,  furnace,  hot  water  and  steam. 

Open  Fire  or  Grate.  —  The  heat  is  transmitted  chiefly  by  radiation 
so  that  a  person  facing  the  fire  may  be  quite  cold  in  the  back.  Most 
of  it  passes  up  the  smoke  flue  and  is  lost.  This  method,  therefore, 
although  pleasant  and  cheerful,  is  quite  wasteful.  Much  air  is 
drawn  into  the  room  by  the  aspiration  of  the  chimney ;  according  tc 
Notter  and  Firth,  the  best  type  of  open  fireplace  causes  some  2,600 


HEATING. 


547 


cubic  feet  of  air  to  pass  up  the  flue  per  pound  of  coal  consumed,  or 
about  18,000  cubic  feet  per  hour,  but  this  air  is  drafty  and  does  not 
diffuse  itself.  There  are  ways,  however,  of  utilizing  open  fires  and 
grates  for  better  heating  and  ventilation  as,  for  instance,  that  shown 
in  Fig.  153,  in  which  fresh  air,  warmed  by  the  fireplace  and  smoke 
flue,  enters  above  and,  after  diffusing  itself  in  the  room,  is  drawn 
up  through  the  hearth. 


FIG.  153. —  Method  of  heating  and  ventilating  by  open  fire. 

Stoves.  —  Stoves  heat  by  radiation  and  convection.  They  are  the 
most  economical  and  efficient  mode  of  heating,  utilizing  from  80  to 
90  per  cent,  of  available  caloric.  On  the  other  hand,  they  are  noisy 
and  dusty ;  they  dry  the  air  to  a  trying  degree  and  scorch  the  or- 
ganic particles  floating  in  it,  injuring  its  respirable  qualities  and 
causing  unpleasant  odors.  A  red-hot  cast-iron  stove  may  also  per- 
mit the  highly  poisonous  carbonic  monoxid  to  pass  through  it.  There 
is  likewise  danger,  if  the  damper  is  closed  or  the  draft  otherwise 
imperfect,  of  gases  escaping  from  it.  These  objections,  however, 
can  to  a  large  extent  be  remedied  by  careful  management.  The  ease 
with  which  stoves  can  be  utilized  for  ventilation  is  one  of  their 
advantages.  Thus  Fig.  154  shows  how  barracks  can  be  heated  and 
ventilated  by  the  simple  device  of  surrounding  the  stoves  with  a 
sheet-iron  jacket  which  keeps  the  cold  incoming  air  (brought  under 
the  floor  from  the  outside)  long  enough  in  contact  with  the  metal  to 


548 


MILITARY    HYGIENE. 


warm  it  to  a  suitable  temperature.  The  stovepipes  run  into  and 
out  of  a  ventilating  shaft;  but  if  the  latter  is  capped  with  a  star 
ventilator  (a  preferable  method)  the  pipes  terminate  under  it.  The 
shaft  must  have  two  outlets,  one  below,  near  the  floor,  the  other 
above,  near  the  ceiling.  Whenever  the  stoves  are  used,  the  upper 
outlet  is  closed  and  the  lower  open  so  that  the  heated  fresh  air,  after 
ascending,  is  compelled  to  diffuse  itself  downward  to  escape  through 
the  shaft.  The  upper  outlet  is  used  in  summer  to  promote  natural 
ventilation,  and,  occasionally,  in  winter  when  the  foul  air  accumu- 
lates faster  than  can  escape  through  the  lower  vent.  Fig.  155  shows 
an  excellent  type  of  the  so-called  ventilating  stoves  in  which  the 
fresh  air  is  brought  in  contact  with  the  fire-box  before  diffusing 
itself  through  the  room. 


FIG.  154. —  Diagram  showing  the  use  of  stoves  to  heat  and  ventilate  barracks. 

As  an  improvisation,  for  winter  quarters,  especially  where  fuel  is 
scant,  the  "  Russian  stove  "  deserves  to  be  better  known.  In  the 
field  it  consists  simply  of  a  substantial  brick,  stone  or  clay  structure 
through  which  the  flue  is  made  to  describe  several  vertical  curves 
so  as  to  impart  its  heat  to  the  whole  mass.  Once  heated,  very  little 
fuel  is  required  to  maintain  its  temperature.  Such  stove  is  never 
very  hot,  therefore  does  not  unduly  dry  or  char  the  air  and  gives  off 
a  pleasant,  even,  steady,  moderate  heat. 


HEATING. 


549 


Another  economical  improvisation  applicable  to  tents  and  huts  is 
the  Chinese  method  in  which  the  fire  is  built  in  a  pit  in  front  (inside 
or  outside),  and  the  flue  runs,  under  the  floor,  into  an  improvised 
chimney  in  rear. 

With  all  kinds  of  stoves  it  is  very  important  to  see  that  a  sufficient 
degree  of  humidity  in  the  air  is  maintained;  most  of  them  are  pro- 
vided with  receptacles  for  water  and  these  should  always  be  kept 
full;  but  they,  are  generally  insufficient  and  additional  water-pans 
must  be  used. 

Hot-air  Furnace.  —  In  this  method,  the  air  is  heated  in  a  furnace 
in  the  basement  and  conducted  by  means  of  large  galvanized  iron 
pipes  to  all  parts  of  the  building.  It  has  but  little  to  recommend  it 
except  cheapness  of  installation,  which  may  have  to  be  considered  in 
private  dwellings.  It  should  be  used  only  in  buildings  in  which  a 
very  moderate  degree  of  heat  is  needed,  and  should  always  include 
suitable  filters  to  exclude  dust.  It  both  heats  and  ventilates.  The 


FIG.  155. —  Cortland  Howe  ventilating  stove. 


550 


MILITARY    HYGIENE. 


ventilation  is  promoted  by  providing  enough  outlets  for  a  proper  air 
movement;  this  movement  being  outward,  drafts  from  the  outside 
air  are  prevented.  The  disadvantages  of  the  method  are  serious: 
The  heat  is  unevenly  distributed,  its  diffusion  depending  upon  the 
direction  of  the  wind  so  that  the  windward  side  of  the  house  may 
be  cold  and  the  other  side  too  warm,  and  depending  also  upon  the 
length,  slant  and  angles  of  the  pipes,  the  heated  air  moving  readily 
up  vertical  pipes  but  sluggishly  along  nearly  horizontal  and 
crooked  ones.  The  air  often  carries  dust  with  it  which,  from  con- 
tact with  the  hot  furnace,  is  scorched,  rendering  it  irritating  to  the 
throat  and  nasal  passages ;  in  case  of  any  crack  or  leak  in  the  fur- 
nace, it  becomes  dangerously  contaminated  with  coal  gas. 


FIG.   156. —  System  of  piping  for  hot-water  heating  —  Main  flow  and  return 
pipes.     ("Heating  and  ventilating  buildings."  —  Rolla  C.  Carpenter.) 

HOT  WATER.  —  This  method  of  heating,  whenever  applicable,  is 
the  most  satisfactory  for  houses,  barracks,  hospitals  and  public 
buildings.  The  high  specific  heat  of  water  makes  it  an  excellent 
medium  for  the  storage,  transportation  and  distribution  of  heat. 
The  quantity  which  can  be  stored  in  equal  weights  of  water  and  air 
is  in  the  ratio  of  421  to  100,  which  means  that  the  heat  set  free  by 
one  pound  of  water,  cooling  down  one  degree,  will  raise  4.21  pounds 
of  air  (or  55  cubic  feet)  one  degree.  In  practice,  it  is  estimated 
that  one  cubic  foot  of  water,  cooling  one  degree,  will  raise  to  that 
extent  the  temperature  of  3,000  cubic  feet  of  air. 


HEATING. 


551 


The  low-pressure  system  is  practically  always  used,  being  safer 
and  more  easily  controlled  than  the  high-pressure  one.  From  the 
boiler,  in  the  basement,  a  set  of  pipes  convey  the  hot  water  to  all  the 
radiators  in  the  building  and  a  second  set  return  the  cooled  water  to 
the  bottom  of  the  boiler.  (Fig.  156.)  The  system  is  open  above, 
at  its  highest  point  (expansion  tank),  so  as  to  allow  for  the  ex- 
pansion of  the  water,  and  a  vent  is  provided  on  each  radiator  for 
the  escape  of  dissolved  air  liberated  from  the  water.  The  tempera- 
ture of  the  water  averages  180°  and  seldom  reaches  212°.  The 


FIG.  157. —  System  of  piping  for  steam  heating.     (Baldwin.) 

heat,  as  transmitted  from  the  coils,  by  conduction  and  convection,  is 
pleasant,  equable  and  constant,  not  liable  to  rapid  changes.  The 
system  is  noiseless,  very  easily  regulated,  devoid  of  danger  and,  after 
the  first  installation,  cheaper  than  steam  heating. 

STEAM.  —  Steam  is  still  more  efficient  than  water  as  a  medium 
for  the  absorption,  storage  and  transmission  of  heat  on  account  of 
the  enormous  quantity  of  latent  caloric  which  it  sets  free  on  con- 
densing. Thus  one  pound  of  steam  condensing  to  boiling  water 
gives  off  enough  heat  to  raise  the  temperature  of  22.5  pounds  of  air, 
or  5.36  pounds  of  water,  to  212°.  Steam  has  been  more  generally 
used  than  hot  water  in  this  country  because  of  the  cheaper  and  easier 
installation.  The  coils  are  smaller,  more  compact  and  no  return 
pipes  are  required.  (Fig.  157.)  The  heat  can  be  turned  on  or  off 
much  more  rapidly,  and  by  dividing  the  coil  in  several  sections,  as 
many  sections  are  used  as  needed  to  obtain  the  exact  degree  desired. 
As  the  temperature  in  the  pipes  may  reach  and  even  exceed  225° 
there  is  some  danger  of  scorching  the  air.  An  advantage  of  steam 
over  hot  water  is  that  it  travels  great  distances  with  rapidity  and 


552 


MILITARY    HYGIENE. 


without  condensation  provided  the  mains  are  sufficiently  large  and 
well  insulated.  It  is  also  much  more  efficient  for  the  heating  of  the 
upper  stories  of  tall  buildings.  It  is  likewise  preferable  in  very  cold 
countries,  being  much  less  affected  by  a  temperature  below  zero. 
The  chief  defect  of  steam  heating  is  the  so-called  "  water-hammer," 
a  loud  percussion  noise  produced  whenever  condensation  water  forms 
in  the  coils,  and  the  steam,  forcing  its  way,  projects  it  against  the 
sides  of  the  pipes. 


I 

FIG.  158. —  Indirect    system   of    heating.      (Bashorc's   "Outlines   of   practical 

sanitation.") 

Location  of  Coils.  —  With  either  hot  water  or  steam,  the  location 
of  the  coils,  within  the  room,  does  not  matter  much,  depending  upon 
its  shape  and  the  disposition  of  the  furniture.  Generally  they  are 
best  placed  under  the  windows  so  as  to  be  out  of  the  way  and,  at  the 
same  time,  warm  the  cold  air  leaking  through  or  flowing  down  from 


HEATING. 


553 


the  chilling  panes.  It  is  also  the  best  place  to  receive  the  cold  air 
from  ventilating  inlets  as  is  commonly  done  in  our  barracks  and 
hospitals.  If  not  placed  under  the  windows,  it  is  best,  in  dormitories 
or  wards,  to  set  them  along  the  median  line  so  as  to  be  nearer  the 
feet  than  the  heads  of  the  sleeping  men. 

It  should  be  remarked  that  the  designation  of  radiators,  given  to 
heating  coils,  is  a  misnomer  inasmuch  as  they  heat  mostly  by  con- 
duction and  convection,  and  least  by  radiation. 


FIG.  159. —  Direct-indirect  system  of  heating. 

SYSTEMS  OF  HEATING.  —  It  has  been  seen  that  the  source  of  heat 
can  be  in  the  room  itself,  and  not  directly  connected  with  ventilation, 
as  with  common  stove,  open  fire  or  grate,  steam  or  hot  water  radi- 
ator; this  is  the  direct  system.  When  the  air  is  heated  before  enter- 
ing the  room,  either  through  a  hot-air  furnace  or  by  passing  over 
steam  coils,  and  is  used  for  heating  and  ventilation,  the  system  is 
said  to  be  indirect.  (Fig.  158.)  In  the  direct-indirect  system,  the 
source  of  heat  is  in  the  room  and  the  air  supply  is  brought  in  contact 


554  MILITARY    HYGIENE. 

with  it,  as  in  the  case  of  jacketed  or  "ventilating"  stoves,  and  of 
hot-water  or  steam  coils  with  cold-air  inlets  introduced  under  them. 
(Fig.  159.) 

As  has  already  been  stated,  it  is  desirable  that  the  incoming  fresh 
air,  in  winter,  should  be  moderately  warmed  before  entering  an  oc- 
cupied room.  When  the  building  is  heated  by  hot  water  or  steam, 
the  air  may  be  admitted  through  the  walls  directly  to  the  coils 
(direct-indirect  system),  in  which  case  it  abstracts  some  of  their 
heat  so  that  more  coils  are  required ;  or  else  the  air  is  passed  over 
steam  coils  in  the  basement  and  introduced  into  the  room  through  a 
sufficient  number  of  registers  (indirect  system),  in  which  case  it 
brings  additional  heat  to  that  furnished  by  the  coils. 

HEAT  AND  AIR  DUST.  —  It  has  been  seen  that  when  subjected  to 
artificial  heat,  the  air  loses  its  freshness  and  becomes  more  or  less 
"  dead "  and  "  stuffy."  The  exact  nature  of  the  change  is  not 
known,  but  there  is  no  doubt  that,  to  a  large  extent,  it  may  be  at- 
tributed to  the  effect  of  heat  upon  the  air  dust.  Prof.  Esmarch  has 
demonstrated  that  dust,  especially  when  of  organic  nature,  will 
begin  to  decompose  on  heating  surfaces  at  a  temperature  of  about 
160°  F.  Of  the  gases  produced,  ammonia  can  be  detected  in  all 
parts  of  the  room.  Even  when  the  heating  surfaces  were  carefully 
cleaned,  before  the  test,  the  effect  on  the  air  was  still  noticable, 
showing  that  the  dust  suspended  in  air  will  also  decompose  when 
passing  over  heating  surfaces  and  without  contact  with  them.  Prof. 
Nussbaum  found  that  moist  organic  dust  will  begin  to  decompose 
even  at  140°,  while  dry  dust  must  be  heated  to  about  200°  before 
gases  become  detectible.  In  this  respect,  however,  moist  dust  does 
not  play  an  important  part.  Whatever  of  it  there  may  be  in  inhab- 
ited rooms  will  usually  lie  on  the  floor  and,  by  reason  of  its  weight, 
show  no  tendency  to  rise  and  come  in  contact  with  radiators  until  it 
has  lost  most  of  its  moisture.  It  is  not  believed  that  the  degree  of 
relative  humidity  necessary  for  the  best  condition  of  the  air,  can 
have  any  appreciable  effect  in  favoring  this  decomposition  of  organic 
dust.  On  the  contrary,  it  has  been  seen  that  a  suitable  degree  of 
humidity  renders  possible  a  lower  degree  of  heat.  It  is  evident 
however,  that  where  circumstances  require  the  combination  of  a 
relatively  high  temperature  and  high  degree  of  humidity  the  careful 
filtering  or  washing  of  the  air  is  very  important. 

The  effect  of  heat  on  ozone  is  also  noteworthy.     The  tendency  of 


HEATING.  555 

ozone  to  combine  with  organic  matter  increases  with  the  tempera- 
ture, and  a  point  is  soon  reached  at  which  no  more  ozone  is  found  in 
the  air ;  thus  it  is  safe  to  assume  that  no  ozone  can  get  past  a  radiator 
or  stack.  It  is  probable  that  a  certain  amount  of  oxygen  is  also 
sacrificed  by  the  process  of  heating.  This  absorbtion  of  ozone  would 
account,  in  a  measure,  for  the  lifeless  quality  of  air  flowing  from  a 
register  or  ascending  from  a  radiator. 

The  dust  is  carried  up  and  kept  in  motion  by  the  currents  of  warm 
air,  thus  adding  certain  obnoxious  elements  to  the  air  we  breathe. 
This  movement  of  the  dust  is  well  demonstrated  by  the  black  streaks 
which  it  often  leaves  oh  white  walls  above  radiators.  These  streaks 
show  also  that  it  is  sufficiently  scorched  to  discolor  the  walls.  But 
it  is  not  likely  that  live  organisms  are  destroyed  to  any  extent  by  the 
ordinary  forms  of  heating  apparatus;  these  merely  dry  and  char 
the  dust  and  keep  it  in  motion.  "  Considering  this,  we  are  forced 
to  admit  that  heating  increases  the  bacterial  contents  of  the  air  " 
(Konrad  Meier).  The  effect  of  this  air  contamination  is  shown 
by  the  increase  of  nose,  throat  and  bronchial  ailments  in  winter, 
especially  when  many  people  work  in  the  same  shops  or  sleep  in  the 
same  dormitories.  The  great  increase  of  tonsillitis  among  soldiers 
in  barracks,  during  the  winter  months,  has  already  been  referred  to 
(page  4).  In  accounting  for  this,  another  contributory  element 
comes  into  action,  namely,  the  usually  low  relative  humidity  of  the 
air,  causing  an  abnormal  dryness  of  mucous  membranes  and  the 
partial  loss  of  their  bactericidal  qualities.  In  a  word,  we  have  an 
increase  of  air  pollution,  together  with  a  decrease  of  resistance 
against  it. 

Experience  shows  that  in  spite  of  whatever  devices  used  to  that 
end,  dust  cannot  be  entirely  excluded  from  buildings  and  that  we 
must  contend  with  it. 

The  best  way  to  prevent  the  chemical  adulteration  of  air  through 
the  decomposition  of  organic  matter  is  by  a  moderate  temperature 
of  dust-free  surfaces.  With  clean  surfaces  and  air  reasonably  dry 
there  will  be  no  vitiation  with  a  temperature  (of  heating  surfaces) 
under  160°  F.,  letting  it  rise  only  occasionally  to  180°  during  unus- 
ually cold  spells.  For  this  moderate  degree  of  heat,  hot  water  is 
more  suitable  than  steam. 

If,  as  Fliigge  contends,  the  convection  of  heat  from  the  body  is  a 
necessary  function  of  the  system,  it  is  promoted  by  heating  at  low 


556  MILITARY    HYGIENE. 

tension,  which  means  by  extended  surfaces  at  relatively  low  tem- 
perature, giving  off  heat  mostly  by  radiation  and  least  by  convec- 
tion, sufficient  to  warm  the  occupants  of  the  room  without  greatly 
affecting  the  ambiant  air.  The  devices  which  give  the  best  radiant 
heat  and  the  least  air  currents  are  also  the  easiest  to  clean.  Enamel 
finish  in  black  and  white  will  help  in  radiating  efficiently  and,  by 
showing  the  dust,  will  insure  clean  surfaces.  It  is  insanitary  to 
place  heating  surfaces  overhead  or  in  any  place  out  of  reach  and 
sight  where  the  dust  will  accumulate.  Floor  registers  nearly  always 
become  receptacles  for  dust  and  are  likewise  objectionable. 


CHAPTER  XLV. 
LIGHTING. 

Light  is  necessary  to  the  growth  and  development  of  animals  and 
plants.  Upon  animals  it  favors  metabolism,  improves  the  quality  of 
the  blood  and  promotes  the  performance  of  all  functions.  With  the 
exception  of  the  lower  cryptogams,  plants  thrive  only  under  the 
influence  of  light ;  it  is  only  under  such  influence  that  they  perform 
the  all-important  nutritive  function,  through  their  green  foliage,  of 
decomposing  the  carbon  dioxid  of  the  air,  appropriating  the  carbon 
and  giving  off  the  oxygen.  But  light,  on  the  other  hand,  is  inimical 
to  low  forms  of  fungi,  including  all  microbes  and  bacteria,  inhibiting 
their  growth  or  killing  them  outright.  Therefore  it  appears  that 
while  strengthening  man,  sunlight  destroys  some  of  his  silent  foes, 
the  pathogenic  micro-organisms.  Hence  the  necessity  of  a  suffi- 
ciency of  window  surface  in  all  buildings;  this  surface  should  be 
equal  to  at  least  one-fifth  of  the  floor  area,  or  one  square  yard  for 
each  30  cubic  yards  of  space.  In  cold  or  temperate  climates,  the 
windows  should  be  disposed  on  at  least  two  sides  of  the  buildings  so 
that  the  sun-rays,  if  possible,  may  reach  all  parts  of  the  floor.  This 
is  especially  desirable  in  buildings  occupied  by  many  people,  such  as 
barracks,  schools,  factories,  etc. 

In  thus  providing  light  and  sunshine  it  is  very  important  to  con- 
sider the  climate  and  season.  The  calorific  and  luminous  properties 
of  the  solar  rays  are  stimulating  and,  to  a  certain  point,  necessary 
for  the  proper  work  of  the  bodily  functions,  but,  beyond  that  point, 
they  become  depressing  and  harmful ;  for  instance,  the  sunlight 
which  is  cheering  and  invigorating  in  winter  may  be  intolerable  and 
dangerous  in  summer.  In  tropical  countries,  the  sun,  during  the  hot 
season,  is  often  the  worst  enemy  that  the  white  man  has  to  encounter 
and  measures  must  be  taken,  not  to  exclude  it  altogether,  but  to 
mitigate  its  unpleasant  effects.  Therefore  the  houses  should  face 
north  and  be  protected,  at  least  on  the  south  and  west  sides,  by  broad 
verandas.  Not  only  the  sun-rays  should  be  excluded,  but  the  diffused 
light  itself,  when  very  bright,  must  be  subdued.  Dazzling  white 
surfaces  are  particularly  objectionable  and,  in  warm  climates,  the 

557 


MILITARY    HYGIENE. 

law  should  require  that  all  outside  walls  be  lightly  tinted.  In  rooms 
lighted  with  electricity  the  walls  should  likewise  be  colored  with  a 
soft  neutral  tint. 

According  to  J.  H.  Parsons  and  other  authorities,  ultra-violet  rays 
are  deleterious  to  the  eye  and,  in  men  exposed  to  bright  electric  light 
for  instance,  liable  to  produce  various  effects  on  lens  and  retina, 
but  especially  intense  congestion  and  inflammation  of  the  conjunc- 
tiva. Snow  blindness  is  also  believed  to  be  due  to  the  same  rays. 
Good  protection  is  afforded  by  plane,  clear  glass  spectacles  which 
cut  off  all  ultra-violet  rays  of  shorter  wave  length  than  300  microns. 
Blue  glasses  or  smoked  glasses  are  better,  but  still  more  effective  are 
amber  glasses  or  glasses  tinted  greenish-yellow,  which  are  said  to 
absorb  all  rays  below  400  microns.  Suitable  protective  glasses,  such 
as  reduce  the  intensity  of  light  and  cut  off  its  actinic  rays,  are  espe- 
cially needed  by  men  exposed  to  search-lights. 

Location  of  Lights.  —  Dazzling  lights  should  be  removed  from 
the  field  of  vision  or  else  softened  by  shades  or  globes.  The  so- 
called  indirect  method  of  illumination  is  a  valuable  innovation  in 
which  the  light  (from  invisible  sources)  is  thrown  onto  the  ceiling 
and  reflected  in  a  soft  diffuse  form  throughout  the  room.  This 
method  prevents  glare,  gives  an  illumination  free  from  distinct 
shadows  and  is  the  nearest  approach  to  daylight  that  it  is  possible  to 
secure  by  artificial  means.  In  the  semi-indirect  method  the  reflector 
is  made  of  translucent  glass  so  that  it  is  mildly  luminous  itself. 

In  the  study  or  class-room,  the  reading  or  writing  desk  should 
be  placed  so  as  to  be  clearly  lighted,  free  from  shadow  and  glare. 
The  glare  likely  to  be  caused  by  reflection  of  the  light  upon  the 
paper,  especially  when  flat  desks  are  used,  may  be  very  trying;  it 
should  be  prevented  by  changing  the  angle  of  incidence  of  the  rays. 
Since  reading  and  writing  are  from  left  to  right,  it  is  best  to  have 
the  window  on  the  left  so  that  no  shadow  be  projected  on  the  book 
or  paper  where  the  sight  is  focused.  It  must  not  be  in  front,  for 
every  time  the  eyes  look  up  through  it,  at  any  outside  object,  there 
is  a  change  of  focusing  accommodations,  followed  by  another  as 
soon  as  the  reading  or  writing  is  resumed,  causing  fatiguing  eye- 
strain.  Artificial  lights  should  be  white,  bright  and  steady;  they 
may  be  placed  on  the  left  or  in  front,  so  that  no  shadow  shall  be 
thrown  upon  the  field  of  vision,  and  must  always  be  shaded  in  order 
to  concentrate  their  power  and  protect  the  eye. 


LIGHTING.  559 

Use  of  Prismatic  Glass.  —  When  a  room  is  lighted  only  by  front 
windows,  its  rear  part  can  be  rendered  much  brighter  by  the  use,  in 
these  windows,  of  prismatic  or  ribbed-glass  panes  which  refract  the 
luminous  rays  in  a  horizontal  direction  and  light  up  all  parts  of  the 
room,  if  not  too  deep. 

ILLUMINANTS. 

The  illuminants  most  generally  used  are  candles,  petroleum,  coal 
gas,  acetylene  and  electricity.  With  the  exception  of  electricity, 
they  all  absorb  oxygen  while  burning,  and  give  off  carbon  dioxid, 
vapor  of  water  and  other  products  of  combusion  which  pollute  the 
air. 

In  all  illuminants,  luminosity,  or  lighting  power,  is  to  be  dis- 
tinguished from  their  heating  power.  During  their  combustion,  the 
hydro-carbons,  of  which  they  are  largely  composed,  break  down  and 
set  free  the  hydrogen  and  multitudes  of  carbon  particles.  In  an 
ordinary  flame,  the  oxygen  of  the  air  is  not  sufficient  to  combine  at 
once  with  all  these  constituents.  As  the  carbon  particles  pass  out- 
ward through  the  flame  of  the  burning  hydrogen,  they  are  not  oxid- 
ized but  heated  to  such  a  point  that  they  become  incandescent, 
thus  causing  the  luminosity  of  the  flame ;  as  they  reach  the  edge 
of  the  light  they  are  converted  into  carbon  dioxid.  Whenever 
it  is  possible  to  furnish  enough  air  to  the  flame,  as  in  the  Bunsen 
burner,  to  combine  with  all  its  constituents  at  once,  the  carbon  par- 
ticles are  converted  into  carbon  dioxid  as  soon  as  set  free,  producing 
an  intense  heat  but  no  luminosity. 

Candles.  —  When  necessary  for  the  public  service,  the  Q.  M.  Corps 
may  issue  candles  in  the  proportion  of  24  ounces  to  each  100  rations, 
or  32  ounces  in  Alaska.  Lantern  candles  are  issued  in  such  quan- 
tities as  the  commanding  officer  deems  necessary. 

Petroleum,  when  properly  used,  is  an  excellent  illuminant,  giving 
a  soft  bright  light,  without  objectionable  odor  or  poisonous  prop- 
erties. It  is  still  largely  burned  at  many  of  our  military  posts, 
although  being  gradually  replaced  by  gas  or  electricity. 

GAS.  —  The  ordinary  coal  gas,  made  by  heating  bituminous  coal 
in  fire-clay  retorts,  consists  chiefly  of  about  50  parts  of  hydrogen,  35 
of  carbureted  hydrogen  (marsh-gas)  and  6  or  7  of  carbon  monoxid. 
Water-gas,  now  extensively  used,  is  made  by  the  action  of  steam 
upon  coke  or  anthracite  coal  heated  to  a  very  high  temperature ;  the 


560  MILITARY    HYGIENE. 

steam  is  decomposed  and  its  oxygen  combines  with  the  carbon  to 
form  carbon  monoxid.  This  gas  is  usually  carbureted,  that  is, 
passed  through  hot  chambers  charged  with  petroleum  where  it  ab- 
sorbs a  supplement  of  carbon  to  increase  the  luminosity  of  its  flame. 
Water-gas  contains  about  35  parts  of  hydrogen,  30  of  carbon  mon- 
oxid and  20  of  marsh-gas.  In  whichever  way  prepared,  gas  is  very 
poisonous  owing  to  the  carbon  monoxid  it  contains;  water-gas  con- 
taining four  or  five  times  more  of  it  than  ordinary  coal  gas  is  pro- 
portionately more  dangerous ;  its  odor  is  also  much  less  pronounced 
so  that  its  presence,  from  leakage  or  open  burners,  is  not  so  readily 
detected  (see  page  528).  As  its  use  has  become  more  general  dur- 
ing the  last  fifteen  years,  the  number  of  deaths  caused  by  it,  acci- 
dental and  suicidal,  has  increased  so  rapidly  that  the  enactment  of 
legislative  measures  to  restrict  the  amount  of  the  deadly  carbon 
monoxid  to  a  safe  proportion  (less  than  20  per  cent.)  would  seem 
to  be  clearly  in  the  interest  of  every  community. 

The  usual  products  of  combustion  of  gas,  besides  carbon  dioxid 
and  vapor,  are  small  amounts  of  carbon  monoxid,  ammonia  and 
sulphur  compounds.  Furthermore,  each  cubic  foot  of  gas,  in  burn- 
ing, generates  enough  heat  to  raise  the  temperature  of  1,160  cubic 
yards  of  air  i°. 

Burners  have  been  devised  to  increase  the  luminous  intensity  of 
the  flame  with  smaller  consumption  of  gas,  therefore  with  less  vitia- 
tion and  heating  of  air.  Such  are  the  so-called  "  regenerative  burn- 
ers "  in  which  the  gas  is  mixed  with  hot  air,  that  is,  air  heated  by  the 
flame  itself.  The  most  satisfactory,  however,  are  the  incandescent 
burners  and,  of  these,  the  Welsbach  is  the  best  known  and  most 
used.  It  consits  of  the  ordinary  Bunsen  burner,  over  the  flame  of 
which  is  hung  a  mantle  of  incombustible  material.  This  mantle  is 
usually  made  by  saturating  a  delicate  network  of  cotton  in  a  strong 
solution  of  earthy  oxids.  When  heated  by  the  Bunsen  flame  it  be- 
comes incandescent  and  intensely  luminous,  a  remarkable  instance 
of  heat  transformed  into  light.  The  Welsbach  burner  consumes 
nearly  one-half  less  gas  than  the  ordinary  burners,  producing  there- 
fore only  one-half  the  heat,  carbon  dioxid  and  other  products  of 
combustion,  while  its  illuminating  power  it  at  least  three  times  that 
of  the  incandescent  electric  light. 

ACETYLENE.  —  This  gas  is  obtained  by  the  action  of  water  upon 
calcium  carbide.  It  gives  a  very  brilliant  white  light,  with  an  ilium- 


LIGHTING.  5OI 

inating  power  about  equal  to  that  of  the  Welsbach  incandescent 
burner.  It  requires  a  special  burner  consisting  of  two  tips,  each 
with  a  minute  orifice  or  slit,  the  two  opposed  jets  forming  a  small 
thin  flame  able  to  secure  enough  oxygen  for  the  complete  combustion 
of  the  gas.  Carbonization,  however,  is  liable  to  occur  on  the  tips 
and  obstruct  the  orifices.  Acetylene,  notwithstanding  its  very  un- 
pleasant odor  of  garlic,  is  not  as  poisonous  as  coal  gas.  When 


FIG.   160.— Acetylene  outfit  for  field  hospital.     (Colt  system.) 

mixed  with  air  there  is  danger  of  serious  explosion  in  contact  with 
light,  so  that  care  must  be  taken  that  the  piping  and  fittings  are  tight 
and  sound*. 

The  advantages  of  acetylene,  besides  its  intense  illuminating  power, 
are  its  cheapness,  being  the  least  expensive  of  all  illuminants,  and 
the  facility  with  which  it  can  be  produced  in  any  place.  It  is  espe- 


562  MILITARY    HYGIENE. 

cially  valuable  for  military  purposes  on  account  of  the  portability, 
simplicity  and  ease  of  operation  of  the  generator.  In  our  service, 
a  small  but  complete  acetylene  outfit,  consisting  of  generator,  rubber 
piping,  burners,  reflectors,  etc.,  weighing,  with  chest,  74  pounds,  is 
supplied  to  each  field  hospital  for  the  lighting  of  the  operating  and 
dispensing  tents.  (Fig.  160.)  Two  such  outfits  are  allowed  a  sta- 
tionary hospital  and  three  to  a  base  hospital.  The  generator,  of 
about  the  size  of  a  water  pail,  contains  two  pounds  of  carbide  and 
can  maintain  four  25-candle-power  burners  for  four  hours,  before 
being  resupplied.  Fig.  161  shows  the  application  of  the  system  to  a 


FIG.   161. —  Hospital  tents  lighted  with  acetylene  gas.     (Colt  system.) 

hospital  ward  under  canvas.  Small  acetylene  lamps,  secured  in 
front  of  the  cap  by  an  elastic  band,  to  be  used  at  night  by  hospital 
corps  men  in  searching  for  the  wounded  and  other  purposes,  have 
also  been  experimented  with  and  found  very  satisfactory. 

Prof.  Jacquemet,  of  Grenoble,  has  devised  an  acetylene  apparatus 
whereby  light  or  heat,  or  both,  in  any  desired  proportion,  can  be 
instantly  generated.  It  is  said  to  be  transportable,  easily  operated 
and  safe. 

Electricity  is  the  ideal  illuminant  and  should  always  be  preferred 
when  available.  Used  in  the  form  of  the  incandescent  lamp,  it  gives 
a  white,  steady,  brilliant  light  of  at  least  i6-candle  power.  The 


LIGHTING.  563 

tungsten  lamp,  as  lately  perfected,  yields  a  still  more  brilliant  light 
and  at  less  cost.  As  this  light  is  not  the  result  of  combustion  and 
does  not  absorb  oxygen  from  the  air,  no  contaminating  product  is 
given  off  and  the  composition  of  the  air  is  in  no  way  affected.  Its 
feeble  heating  power  renders  it  particularly  valuable  for  tropical 
climates,  but  less  desirable  than  gas  where  lights  are  depended  upon 
to  create  an  upward  ventilating  current. 

The  respective  cost  of  illuminants,  for  each  candle  power,  per 
hour,  is  estimated  as  follows:  Tallow  candle,  4  cents;  gas,  bat's- 
wing  burner,  0.76  cent ;  electric  incandescent  lamp,  0.60 ;  petroleum, 
0.54 ;  Welsbach  incandescent  gas  lamp,  0.32 ;  acetylene,  0.20. 


CHAPTER  XLVI. 
EXCEETA,  GARBAGE  AND  WASTES. 

By  excreta  must  be  understood  all  waste  matters,  solid  and  liquid, 
eliminated  from  the  human  body,  such  as  feces,  urine,  sweat,  as  well 
as  discharges  from  the  mouth,  nose  and  lungs.  Garbage  refers 
chiefly  to  kitchen  refuse,  including  much  animal  and  vegetable  mat- 
ters in  the  shape  of  food  debris.  The  waste  waters  which  hygienists 
are  most  concerned  with  are  those  from  kitchen  sinks,  lavatories, 
baths  and  laundries. 

The  average  daily  discharge  of  fresh  fecal  matter,  per  male  adult, 
is  5  ounces,  and  of  urine  45  ounces.  In  a  mixed  community,  includ- 
ing men,  women  and  children,  the  average  per  head  may  be  estimated 
at  3  ounces  of  feces  and  32  ounces  (i  quart)  of  urine.  Fecal  matter 
contains  75  per  cent,  of  water  and  22  per  cent,  of  organic  substance 
of  which  2.2  is  nitrogen.  Urine  contains  95  per  cent,  of  water  and 
1.4  of  nitrogen.  Feces  are  quickly  putrescible,  their  decomposition 
often  beginning  before  being  discharged,  owing  to  the  agency  of  the 
saprophytic  microbes  which  swarm  in  them.  These  microbes  bring 
about  their  transformation  into  simple  harmless  substances  and 
therefore  play  a  useful  part  in  the  economy  of  nature;  but  excreta 
may  also  contain  pathogenic  bacteria  of  various  kinds  and,  on  that 
account,  are  always  open  to  suspicion. 

SEWERAGE  AND  PLUMBING. 

The  general  system  whereby  excreta  and  wastes  are  removed  by 
water  through  fixtures,  pipes  and  drains  into  sewers  or  other  place 
of  final  disposal,  is  called  sewerage ;  while  sewage  is  the  name  given 
to  the  contents  of  drains  and  sewers. 

A  good  sewerage  system  requires  an  abundant  water-supply  for 
the  flushing  of  fixtures  and  drains,  with  sufficient  outfall  and  effec- 
tive means  of  final  disposal ;  it  must  be  well  and  substantially  con- 
structed, of  excellent  material,  perfectly  water-tight  and  thoroughly 
ventilated. 

The  marked  effect  of  sewerage  upon  human  health  has  long  since 
been  conclusively  demonstrated.  The  excreta  likely  to  contain  the 

564 


EXCRETA,    GARBAGE    AND    WASTES.  565 

germs  of  typhoid  fever,  dysentery  and  cholera  are  carried  to  a  safe 
place  of  final  disposal  instead  of  lurking  in  pits,  vaults  and  cesspools ; 
furthermore,  many  of  the  dangerous  waste  waters  that  would  other- 
wise be  thrown  into  yards  or  leaky  receptacles  also  find  their  way  to 
the  sewers,  with  resulting  improvement  in  the  cleanliness  and  dryness 
of  grounds.  It  is  a  well-known  fact  that  the  construction  of  a  sew- 
erage system  in  a  city  is  immediately  followed  by  a  decrease  in  its 
mortality  and  that,  next  to  the  introduction  of  a  pure  water-supply, 
it  is  the  most  important  factor  in  reducing  the  death-rate  of  infec- 
tious diseases,  especially  of  typhoid  fever  which,  of  them  all,  is  the 
one  that  most  readily  responds  to  sanitary  improvements. 

The  popular  fear  of  sewer  air  or  emanations  has  been  shown  to 
be  groundless.  This  air  contains  more  CO2  and  organic  matter 
than  pure  outside  air,  but  fewer  micro-organisms,  in  fact  much 
fewer  than  are  found  in  dwellings.  Bacteria  abound  in  sewage  but 
hardly  ever  find  their  way  into  the  air  above  it,  so  that  sewer  air  is 
incapable  of  conveying  typhoid  fever  or,  so  far  as  known,  any  other 
infectious  disease.  It  is  a  matter  of  record  that  men  working  in 
sewers  are  strong  and  healthy,  and  have  a  low  death-rate.  Plumb- 
ing fixtures  properly  trapped  completely  exclude  sewer  air,  so  that 
if  foul  smells  are  noticed  they  are  almost  always  due  to  the  decom- 
position of  excreta  or  other  organic  matter  within  the  fixtures,  pipes 
or  traps.  Such  smells  may  produce  headache  and  affect  the  appetite 
and  digestion,  and  therefore  are  to  be  avoided,  but  seldom  have 
serious  or  dangerous  effects. 

The  plumbing  system  of  a  dwelling  consists  of  fixtures  (closets, 
lavatories,  sinks,  tubs,  etc.),  waste  pipes,  traps,  soil  pipe  and  drain 
(Fig.  162).  The  waste  pipes  connect  the  fixtures  with  the  soil  pipe. 
They  are  generally  of  lead  on  account  of  its  malleability,  but  when 
too  many  bends  are  not  required  iron  is  preferable.  They  must 
always  be  readily  accessible  so  that  leakage  be  easily  discovered  and 
repairs  made.  Their  diameter  should  seldom  exceed  2,  to  3  inches 
in  order  to  secure  a  rapid  flow  and  thorough  scouring.  They  are  as 
short  and  direct  as  possible  and  gradually  slope  to  the  soil  pipe 
which  they  join  at  an  acute  angle  by  Y-joints.  The  soil  pipe  is  a 
cast-iron  vertical  pipe,  4  inches  in  diameter,  into  which  the  waste 
pipes  empty  the  contents  of  the  fixtures.  Its  segments,  5  feet  long, 
each  with  spigot  and  hub  ends,  are  carefully  and  strongly  jointed 


566 


MILITARY    HYGIENE. 


A    ZamAma. 
B  Baffihiis. 
C    MtterGbstts. 
D    Sfo-Sinfa. 
E    Urinals. 
F 

G    GistlranY'fiiuncAes. 
H 

/     RxhreTnya. 
•J     CasfjmStver. 
K 
L 
M 

N     OakJraa 
0 
P 
Q. 
R 

^     hfrtdjotnf. 
T 
U 


ma*fy>t  Ait  antftnatil 


FIG.  162. — •  Plans  and  elevation  of  typical  main  soil  stack  with  fixtures  and 
connections,  for  standard  36-bed  post  hospital  building. 


EXCRETA,    GARBAGE    AND    WASTES. 


567 


by  gasket  of  oakum  and  well-caulked  molten  lead.  It  should  extend 
clear  through  the  roof  and  project  a  few  feet  above  it,  rising  if 
possible  a  little  above  the  ridge  to  secure  the  advantage  of  wind 
aspiration.  It  should  not  open  over  a  chimney  or  near  a  window 
for  fear  of  unpleasant  odors.  At  the  bottom  it  must  be  firmly  sup- 
ported to  prevent  sagging,  and  make  a  wide  bend  at  its  junction  with 
the  drain.  The  drain  forms  the  continuation  of  the  soil  pipe;  it  is 
also  mostly  of  cast-iron,  its  diameter  depending  upon  the  number  of 
soil  pipes  emptying  into  it.  It  should  have  as  much  slope  as  possible, 
and,  before  passing  out  of  the  house  or  just  outside  of  it  (within  a 
manhole),  be  cut  off  from  the  sewer  by  an  "  intercepting  "  or  "  dis- 
connecting "  trap.  The  soil  pipe  and  drain  are  thus  thoroughly 
ventilated  from  above  and  below. 

When  the  system  is  completed,  its 
tightness  is  tested,  after  filling  the 
traps,  by  pouring  a  few  ounces  of  oil 
of  peppermint,  followed  by  a  few  gal- 
lons of  hot  water,  into  the  top  of  the 
soil  pipe.  Any  leak  will  be  at  once 
discovered  by  a  distinct  odor  of  pep- 
permint in  the  room  where  it  occurs. 
TRAPS.  —  It  is  a  rule  that  each 
plumbing  fixture  must  be  guarded 


FIG.  163. —  Common  S-shaped 
round-pipe  trap. 


by  a  trap,  that  is  to  say,  a  device  which  while  permitting  the  free 
passage  forward  of  liquid  and  suspended  matter  to  the  soil  pipe, 
prevents  the  passage  backward  of  all  air,  gas  or  odor.  The  trap 
should  be  as  near  the  fixture  as  possible  and  admit  of  easy  inspection 
and  cleaning.  The  common  form  consists  of  an  S-shaped  bend, 
filled  with  water,  in  the  fixture  or  waste  pipe.  (Fig.  163.)  As  the 
fixture  is  flushed,  the  excreta  are  forced  through  the  trap,  with 
enough  water  to  clean  and  scour  it  and  afterward  refill  it  to  the 
proper  level.  The  depth  between  the  level  of  the  water  and  the 
lowest  point  of  the  upper  bend  is  called  the  seal.  (Fig.  163.)  This 
is  generally  1^/4  inches.  The  greater  the  seal  the  more  complete  its 
efficiency  but  the  less  perfect  is  the  scouring  of  the  trap. 

The  round-pipe  trap  is  readily  flushed  and,  being  perfectly  smooth, 
keeps  itself  clean,  but  loses  its  seal  easily.  The  flask-trap  (Fig. 
164).  commonly  used  in  barracks  and  hospitals,  is  simple,  durable, 
not  easily  siphoned  out  and  easily  cleaned.  The  bottle  or  pot-traps 


568 


MILITARY    HYGIENE. 


contain  much  water  and  seldom  lose  their  seal  but  require  frequent 
cleaning.  In  the  ball-trap,  which  is  one  of  several  obsolete  mechan- 
ical types,  the  water  displaces  a  ball  which,  by  its  weight,  falls  back 
upon  the  outlet.  The  bell-trap  is  a  form  often  used  in  kitchen 
sinks,  areas  and  gutters,  consisting  of  a  reservoir  containing  water  to 


Outside  view.  Vertical  section. 

FIG.    164. —  Flask   trap.     Quartermaster    Corps    type. 

the  level  of  the  outlet  pipe ;  a  bell  covers  the  mouth  of  the  pipe  and 
dips  into  the  water  (Fig.  165)  ;  it  is  fastened  to  the  strainer  and 
removed  with  it  to  clean  the  reservoir.  The  waste,  after  passing 


Outside  view.  Vertical  section. 

FIG.   165. —  Bell   trap.    Quartermaster   Corps   type. 

through  the  strainer,  reaches  the  reservoir  and  overflows  into  the 
outlet.  The  floor-trap  (Fig.  166)  used  in  mineral  floors  requiring 
washing,  as  in  bath-rooms,  operating-rooms,  etc.,  is  fitted  with  a 
strainer  and  sunk  flush  with  the  floor;  it  contains  a  bent  partition 
with  plug  for  clean-out.  The  disconnecting  or  intercepting  trap  is 


EXCRETA,    GARBAGE    AND    WASTES.  569 

used  to  separate  the  outside  drain  or  sewer  from  the  house  system. 
It  has  a  fresh-air  vent,  as  well  as  inspection  and  clean-out  holes. 
Fig.  167  shows  the  one  advocated  by  Harrington,  in  which  the  outlet 
(S)  is  lower  than  the  inlet  in  order  to  secure  freer  outflow,  and  the 
fresh-air  pipe  (F)  is  placed  far  enough  from  the  trap  not  to  become 
soiled  by  the  splashing  filth. 


FIG.  166. —  Floor  trap. 

Grease-traps  are  intended  to  congeal  and  collect  the  liquid  fat  con- 
tained in  the  warm  waste  waters  of  large  kitchens  and  which,  were 
it  allowed  to  escape,  would  solidify  on  cooling  and  eventually  choke 
the  pipes.  One  of  the  most  efficient  is  the  Tucker  improved.  (Fig. 
168.)  Its  essential  feature  consists  in  being  lined  with  a  chilling 
chamber  which  also  projects  upward  across  it.  The,  entire  cold 
water-supply  passes  through  this  chamber  on  its  way  to  the  boiler 
and  sink,  so  that  the  trap  is  always  kept  cool.  The  flow  of  greasy 
water  is  deflected  upwardly  by  the  hollow  partition,  the  grease  re- 
maining at  the  surface  while  the  water  passes  freely  to  the  waste 
outlet  on  the  other  side.  The  congealed  grease  forms  a  scum  easily 
removed  from  the  top.  Grease-traps  should  always  be  in  a  cool 
place,  generally  outside  the  kitchen.  In  the  absence  of  such  a  trap, 
a  strong  solution  of  lye  should  often  be  thrown  into  the  sink  so  as  to 
saponify  and  dissolve  the  incrusting  fat. 

Loss  OF  SEAL.  —  Traps  are  exposed  to  lose  their  water  seal  and 
thus  become  useless,  by  siphonage,  back-pressure,  evaporation,  capil- 
lary attraction,  leakage  and  accumulation  of  sediment.  The  most 
frequent  and  important  of  these  causes  is  siphonage ;  it  results  from 
the  rapid  discharge,  with  great  momentum,  of  the  mass  of  water 


570 


MILITARY    HYGIENE. 


from  the  trap  without  enough  after-flush  to  refill  it,  or  from  the 
suction  produced  by  a  heavy  column  of  water  falling  down  the  soil 
pipe.  In  loss  of  seal  by  back-pressure,  which  is  uncommon,  the 
process  is  reversed;  the  column  of  water  falling  down  the  soil  pipe 


FIG.   167. —  Improved  intercepting  trap.     (Harrington.) 

and  meeting  with  an  obstruction,  the  compressed  air  is  forced  up  the 
waste  pipe  and  breaks  the  seal.  The  water  of  traps,  especially 
vented  traps,  evaporates  more  or  less  rapidly  according  to  the  tem- 
perature and  the  movement  of  the  air,  so  that  when  a  fixture  remains 
unused  the  seal  is  soon  lost  from  this  cause.  It  is  therefore  neces- 
sary to  flush  the  fixtures  of  a  vacant  house  once  a  week  or,  prefer- 
ably, pour  oil  or  glycerine  into  them.  Capillary  attraction  may 
empty  a  trap  by  means  of  a  rag  or  string  lying  partly  in  the  water 
and  partly  over  the  bend  into  the  outlet. 

Siphonage,  as  well  as  back-pressure,  are  prevented  in  either  of  two 
ways :  by  a  vent  connected  with  the  upcast  branch  of  the  trap,  on 
the  distant  side  of  the  seal,  or  by  the  use  of  a  non-siphoning  trap. 
The  vent  supplies  air  to  the  waste  pipe  on  the  distant  side  of  the  trap 
and  thus  prevents  the  formation  of  any  vacuum  which  would  cause 
the  suction  and  destruction  of  the  seal;  in  case  of  back-pressure  it 
affords  an  exit  to  the  compressed  air.  The  vent  pipe  should  prefer- 
ably be  placed,  not  on  the  summit  of  the  curve  but  a  little  below,  so 


EXCRETA,  GARHAGE  AND  WASTES. 


571 


that  the  sewage  may  not  be  projected  into  it.  (Fig.  169.)  Each 
vent  pipe,  from  the  various  fixtures  of  a  system  of  plumbing,  con- 
nects with  a  main  ventilating  pipe  which,  usually,  runs  alongside  the 
soil  pipe,  both  projecting  above  the  roof;  there  is  no  objection  to 
their  being  connected,  provided  such  connection  be  made  above  the 
highest  fixture.  (Fig.  162.) 


.GOLD  WATER 
SUPPLY  TO  BOILER 


FIG.  168. —  Tucker  improved  grease  trap. 

Non-siphoning  Traps.  —  These  have  been  devised  to  obviate  the 
necessity  of  back-venting  which  is  expensive  and  sometimes  causes 
rapid  evaporation  of  the  seal.  They  are  all  so  constructed  that  air 
may  be  drawn  through  them  by  suction  without  loss  of  much  water, 
a  sufficient  volume  of  it  remaining  to  reform  the  seal.  Among  the 
best-known  traps  of  this  character  are  the  Sanitas  (Fig.  167),  the 


FIG.   169. —  Vent  pipe  properly 
placed. 


FIG.   170. —  Sanitas  trap. 


572 


MILITARY    HYGIENE. 


Hydric  and  Anti-siphon  (Fig.  171).  The  last-named  depends  for 
its  efficiency  on  the  fluid  contents  being  given  a  rotary  motion  in  a 
vertical  plane  in  such  manner  as  to  break  the  siphonic  action  before 
the  contents  of  the  trap  are  withdrawn,  leaving  sufficient  water  to 
form  a  perfect  seal.  These  non-siphoning  traps  are  greatly  more 


FIG.  171.— Anti-siphon  trap. 
Quartermaster  Corps  type. 

economical  than  vent  pipe  and  otherwise  entirely  satisfactory ;  there 
is  no  good  reason  why  they  should  not  be  more  extensively  used 
wherever  applicable,  especially  under  sinks  and  lavatories. 


FIG.   172. — Short-hopper  closet.     (Munson.) 

WATER-CLOSET  FIXTURES.  —  They  should  be  simple,  strong  and 
easily  operated,  with  sufficient  flush  to  wash  out  the  bowl,  sweep 
the  excreta  beyond  the  trap  and  leave  enough  clean  water  to  fill  the 


EXCRETA,    GARBAGE    AND    WASTES. 


573 


trap  and  bowl  to  the  proper  level.  The  bowl  should  be  so  shaped 
that  its  sides  are  not  exposed  to  fouling,  and  the  water  of  such  depth 
as  to  cover  the  discharges. 


FIG.  173. —  Wash-out  closet.     (Bashore's  "Outlines  of  practical  sanitation.") 


FIG.  174. —  Wash-down  closet.     (Bashore.) 


574 


MILITARY    HYGIENE. 


The  specifications  of  the  Quartermaster  Corps  provide  that 
the  .bowls  for  all  water-closets  in  the  army  will  be  of  the  best 
hard-fired  sanitary  vitreous  china,  with  flawless  white  glaze,  the  bowl 
and  trap  moulded  in  one  piece,  that  a  fractured  piece  of  the  material 
must  not  absorb  red  aniline  ink  after  being  immersed  in  it  for  one 
hour;  that  bowls  of  all  types  (except  one)  are  to  be  oval,  with 
siphon-jet,  top  supply  and  heavy  roll-flushing  rim  with  ample  per- 
forations properly  distributed;  that  the  connection  between  each 
closet  and  soil  pipe  will  be  made  with  drawn  lead  pipe  4  inches  inside 
diameter. 

Water-closets  have  undergone  a  marked  evolution  during  the  past 
quarter  of  a  century,  keeping  pace  with  the  more  liberal  water- 
supply  now  considered  necessary  for  the  needs  of  communities. 
The  former  types,  such  as  the  pan,  valve  and  plunger  closets,  still 
seen  in  old  buildings  and  which  are  operated  through  a  complex 
internal  mechanism,  have  the  merit  of  consuming  little  water,  but 


FIG.  175. — Siphon-jet  closet  with 
visible  jet.  Quartermaster  Corps 
type. 


FIG.  176. —  Siphon-jet  closet  with 
both  visible  and  invisible  jets. 
Quartermaster  Corps  type. 


are  always  foul,  malodorous  and  thoroughly  unsanitary.  The  short- 
hopper  closet  (Fig.  1/2),  consisting  simply  of  bowl  and  trap,  with 
rim  flush,  is  a  distinct  improvement.  In  the  wash-out  closet  (Fig. 
173)  the  excreta  are  received  in  a  shallow  basin  and  swept  out  by 
the  flush  into  the  trap  below ;  they  often  adhere  to  the  basin,  fouling 
it,  as  well  as  the  surface  against  which  they  are  projected,  and  often 
partly  remain  in  the  trap.  This  closet,  although  popular  at  one  time, 
has  but  little  to  recommend  it.  The  so-called  wash-down  closet 
(Fig.  174)  is  an  excellent  development  of  the  hopper,  in  which  the 
bowl  forms  part  of  the  trap  and  contains  a  good  depth  of  water. 
But  the  best  modern  type  of  water-closet,  that  which  is  now  gener- 
ally preferred  and  most  used,  is  the  siphon-jet  closet,  of  which  there 


EXCRETA,    GARBAGE    AND    WASTES. 


575 


are  many  forms.  (Figs.  175,  176.)  The  bowl  and  trap  are  moulded 
in  one  piece,  the  bowl  itself  forming  the  inlet  of  the  trap.  The 
flushing  operates  in  two  directions,  washing  the  bowl  from  the  rim, 
while,  at  the  same  time,  a  separate  jet  drives  the  water  from  the 
outlet  of  the  trap  into  the  waste  pipe ;  the  latter  forms  the  long  leg 
of  a  siphon  which,  when  filled,  sucks  out  the  contents  of  the  bowl, 
the  trap  and  basin  being  then  refilled  to  the  proper  level  by  the  after- 
flush.  The  jet  may  be  visible  in  the  bottom  of  the  bowl  (Fig.  175) 
or  invisible  under  the  partition  (Fig.  176).  The  bowl  with  visible 
jet  is  somewhat  more  efficient  and  durable,  but,  on  the  other  hand, 
the  hole  may  become  soiled  and  unsightly  or  clogged.  In  the  siphon- 
jet  closet  the  trap  vent,  in  order  not  to  interfere  with  the  action  of 
the  siphon,  is  placed  below  the  long  leg  of  the  siphon,  generally 
under  the  floor. 


Outside  view. 
FIG.    177. —  Urinal    for  barracks. 


Section  through  bowl. 
Quartermaster   Corps   type. 


In  order  to  secure  more  perfect  ventilation  in  toilet  rooms  and 
prevent  odors  from  the  water-closet,  a  vent  (Boston  or  local  vent) 
is  sometimes  provided  in  the  upper  part  of  the  bowl,  just  above  the 
water  level.  Such  vent,  of  course,  is  entirely  independent  of  the 
trap  vent  and  cannot  take  its  place. 


5/0  MILITARY    HYGIENE. 

URINALS.  —  Modern  urinals  are  constructed  of  hard  vitreous  por- 
celain, with  or  without  bowl.  In  the  latter  case,  the  urine  is  pro- 
jected against  the  walls  of  the  urinal  which  are  constantly  washed 
by  running  water.  The  use  of  bowls  is  more  economical  of  water, 
but  it  is  necessary  that  they  be  large  enough  to  prevent  the  dripping 
of  urine  upon  the  bottom  slab. 

HYGIENE  OF  TOILET  ROOMS. 

These  rooms,  containing  the  water-closets,  urinals,  bath-tubs  and 
showers,  wash-bowls  and  troughs,  and  sometimes  laundry  tubs, 
should  be  scrupulously  clean,  thoroughly  ventilated  and  well  lighted. 
The  lighting  is  facilitated  and  cleanliness  promoted  by  having  as 
many  of  the  surfaces  as  possible  painted  white.  The  floor  should 
be  cemented  or  tiled  and  free  from  cracks  and  crevices  so  as  to  make 
its  flushing  and  mopping  easy  and  effective.  All  tubs,  bowls  and 
troughs  should  be  daily  scrubbed  and  their  outlets  kept  clear  from 
soap,  hair,  paper,  cigar  or  cigarette  stumps,  and  other  refuse  which 
tend  to  clog  them.  Gratings  must  be  lifted  up  and  the  floor  beneath 
flushed  and  scrubbed.  Metallic  surfaces  are  quite  liable  to  become 
oxidized  unless  carefully  rubbed  and  kept  dry.  Water-closets  re- 
quire frequent  inspection  to  insure  cleanliness,  efficient  functioning 
and  adequate  trapping.  When  out  of  order  they  should  be  closed 
until  repaired.  A  bad-smelling  closet  or  urinal  may  be  due  to  defec- 
tive plumbing  but  more  generally  results  from  lack  of  care  in  clean- 
ing the  bowls  and  seats.  When  urinals  with  bowls  are  used,  the  men 
must  be  instructed  to  exercise  care  and  avoid  dripping  in  urination, 
but  such  dripping  is  almost  inevitable  and  will  require  strict  policing. 
In  addition  to  the  usual  flushing,  it  is  well  to  rub  the  bowls,  the 
bottom  slab  and,  when  necessary,  the  side  slabs  with  a  moist  rag 
sprinkled  with  kerosene,  otherwise  a  crust  of  urinary  salts  will  form 
and  bad  odors  arise.  The  outlet  should  be  screened  with  wire  gauze 
to  prevent  clogging. 

As  a  general  rule  no  disinfectant  need  be  used  in  the  toilet  rooms 
beyond  a  light  sprinkling  of  kerosene  on  the  damp  mop  or  cloth  used 
to  wipe  fouled  surfaces.  As  already  insisted  upon,  the  hands  must 
always  be  washed  after  defecation.  A  printed  poster  should  remind 
all  visitors  of  this  duty.  As  no  roller-towels  are  permitted,  it  is 
necessary  that  every  man  coming  to  the  toilet  rooms  should  bring 
his  own  towel  and,  if  needful,  his  own  soap. 


EXCRETA,  GARBAGE  AND  WASTES.  577 

SEWERS. 

Sewers  are  constructed  according  to  the  "  separate  "  or  "  com- 
bined "  systems.  In  the  former,  they  receive  only  the  excreta 
and  waste  waters  of  dwellings ;  in  the  latter,  they  carry  off  not  only 
sewage  but  also  wastes  from  factories,  street  washings  and  rain- 
water. The  separate  system  has  much  to  recommend  it  and  is  often 
the  only  one  possible  in  small  communities;  the  volume  of  sewage 
is  pretty  constant  and  can  be  readily  calculated  from  the  daily  water 
consumption ;  it  is  more  concentrated  and  uniform  in  composition 
than  in  the  combined  system  and  therefore  can  be  better  utilized  or 
disposed  of ;  the  sewers  being  smaller  can  also  be  more  frequently 
and  effectually  flushed.  When  sewage  is  to  be  treated  by  septic 
tanks  and  filter  beds,  better  results  are  obtained  by  the  separate 
system,  with  matters  more  homogeneous  and  not  too  highly  diluted. 
Thus,  for  instance,  whenever  a  city,  in  order  not  to  pollute  a  bay  or 
river,  determines  to  treat  its  sewage  by  irrigation  or  filtration,  it  will 
be  in  the  interest  of  economy,  as  well  as  of  efficiency,  to  build  large 
superficial  conduits  for  storm  water  along  the  shortest  lines  directly 
to  the  bay  or  stream,  and  separate,  deeper  and  smaller  sewers  to 
convey  the  excreta  and  wastes  to  the  disposal  plant  which  may  be 
several  miles  away.  In  this  separate  system,  in  order  to  insure  a 
rapid  flow  and  good  ventilation,  the  pipes  must  not  be  any  larger 
than  necessary;  the  rule  is  that  a  sewer  should  be  at  least  half-full 
at  the  time  of  greatest  flow,  and  that  the  velocity  of  the  flow  should 
not  be  less  than  two  feet  per  second. 

In  the  combined  system  the  size  of  the  sewers  must  be  such  as  to 
accommodate  all  wastes  and  rain-water.  They  may  be  nearly  full 
or,  in  the  dry  season,  contain  only  a  small  sluggish  stream,  offering 
conditions  most  favorable  for  the  settling  of  solids  and  putrefaction 
of  nitrogenous  matters.  It  must  be  remembered,  however,  that  in 
large  cities,  where  this  system  is  generally  used,  the  waste  waters 
alone  are  always  sufficient  to  keep  the  excreta  in  a  state  of  very  free 
dilution.  When  this  is  not  likely  to  be  the  case,  the  smaller  sewers 
should  be  given  an  ovoid  shape  with  the  smaller  end  downward. 


CHAPTER  XLVIL 
EXCRETA,   GARBAGE  AND  WASTES   (CONTINUED)- 

NATURE  OF  SEWAGE  AND  ITS  FINAL  DISPOSAL. 

Sewage  in  this  country  is  largely  diluted,  seldom  containing  more 
than  one  part  of  solids  (mineral  and  organic)  per  thousand,  and 
generally  containing  less  (IVinslow  and  Phelps}.  The  sewage  o£ 
English  cities  may  average  about  twice  as  much  solids,  while  few 
-European  cities  exceed  two  parts  per  thousand.  It  is  therefore,  in 
this  country,  nothing  but  water  more  or  less  polluted,  and  its  amount 
can  be  readily  estimated  from  the  consumption  of  the  water-supply. 
Of  the  total  solids,  one-half  is  mineral  and  one-half  organic;  of  the 
latter,  the  proportion  of  nitrogenous  matter  to  carbohydrates  is  as 
3  to  5.  From  60  to  75  per  cent,  are  in  solution,  the  remainder  being 
insoluble  matter  in  suspension.  The  mineral  matter  in  solution  con- 
sists largely  of  sodium  chloride.  The  amount  of  insoluble  mineral 
matter  is  normally  about  10  per  cent,  of  total  solids  but,  with  com- 
bined sewers,  may  so  increase  from  storm  water  as  to  interfere  with 
the  proper  operation  of  filters. 

The  contents  of  American  domestic  sewage  in  nitrogen  (parts  per 
million)  are  about  24,  15  as  free  ammonia  and  9  as  albuminoid  am- 
monia ;  in  nitrates  0.2  and  in  nitrites  O.O.  The  bacterial  content 
ranges  from  i  to  2  millions  per  c.  c.}  of  which  20  per  cent,  are  acid 
formers  and  8  per  cent,  liquefiers. 

The  final  disposal  of  sewage  is  according  to  the  following  methods : 

1.  Discharge  into  the  sea  or  a  lake  or  river. 

2.  Chemical  treatment. 

3.  Biological  treatment. 

4.  Local  or  domestic  treatment. 

Discharge  into  the  sea,  wherever  possible,  is  the  simplest  and  most 
satisfactory  method,  but  open  to  the  charge  of  unjustifiable  waste  of 
our  national  resources,  involving  the  loss  of  millions  of  tons  of  fer- 
tilizing elements  which  should  be  returned  to  the  soil.  In  1898,  Sir 
Crichton  Browne  estimated  that  in  the  United  Kingdom,  fixed  nitro- 
gen to  the  value  of  no  less  than  80,000,000  dollars  was  thus  thrown 
into  the  sea.  It  is  hoped  that,  through  improved  biological  treat- 

578 


EXCRETA,    GARBAGE   AND    WASTES    (CONTINUED).  579 

ment,  such  amazing  waste  will  become  unnecessary  and  that  the  use- 
ful constituents  of  sewage  may  be  recovered  and  made  available. 

In  the  application  of  this  method,  measures  must  be  taken  that  the 
sewage  be  entirely  carried  away  and  does  not  float  back.  It  is  often 
difficult,  however,  to  prevent  the  pollution  of  neighboring  beaches 
and  shores  by  returning  tides.  Great  care  must  be  exercised  that 
the  sewage  be  only  discharged  from  such  points  and  at  such  stages 
of  the  tide  as  will  insure  its  permanent  removal.  Thus,  at  Fort 
Monroe,  Va.,  it  was  found  necessary  to  collect  the  sewage  into  a 
large  tank  from  which  it  is  pumped  out  to  deep  water,  twice  a  day, 
at  the  setting  out  of  ebb  tide. 

Sewage  can  also  be  safely  discharged  into  any  salt,  tide-water 
stream,  so  long  as  the  tide  and  current  can  be  depended  on  to  carry 
it  to  the  sea.  The  emptying  of  sewers  into  fresh-water  lakes  or 
streams  is  never  advisable  and  should  be  tolerated  only  when  the 
latter  are  not  used  as  sources  of  water-supply.  The  excreta  of  a 
large  city  may  readily  contaminate  the  waters  of  a  lake  for  a  distance 
of  i  or  2  miles  from  the  shore.  It  is  a  fact  that  there  are  now  few 
rivers  in  the  inhabited  districts  of  the  United  States  whose  water 
can  be  safely  consumed  without  previous  purification.  This  preva- 
lent custom  of  discharging  raw  sewage  into  water-courses,  in  well- 
settled  communities,  is  repugnant  as  well  as  dangerous,  and  sanitary 
engineers  are  turning  their  thoughts  to  less  objectionable  methods  of 
disposal.  It  is  highly  probable,  for  instance,  that  the  carriage  of  the 
sewage  of  Chicago  to  the  Illinois  River  would  not  be  approved  at  this 
day.  The  self-purification  of  streams  has  its  rather  narrow  limits; 
the  amount  of  sewage  which  they  can  oxidize  and  dispose  of  is 
roughly  stated  as  I  part  to  50  parts  of  water.  When  that  limit  is 
exceeded  there  is  usually  a  failure  of  available  oxygen ;  the  con- 
ditions of  putrefaction  are  set  up  and  an  objectionable  deposit  of 
decomposing  sludge  takes  place.  The  condition  of  our  rivers  would 
be  vastly  improved  if  the  sewage  should  be  made  to  undergo  some 
form  of  preliminary  treatment,  so  as  to  be  rendered  non-putrescible 
before  being  discharged  into  them. 

CHEMICAL  TREATMENT  consists  in  the  addition  of  chemicals, 
whereby  more  or  less  of  the  putrescible  substances  in  solution  are 
precipitated  and  subsequently  separated,  together  with  all  matters  in 
suspension.  The  solids,  or  "  sludge,"  are  removed,  subjected  to 
hydraulic  pressure  and  utilized  as  fertilizer,  while  the  liquids  may 


580  MILITARY    HYGIENE. 

be  discharged  into  the  sea  or  a  stream.  The  chemicals  most  used 
as  precipitants  are  alum,  lime  and  iron  sulphate,  either  alone  or  in 
combination.  This  system  is  seldom  satisfactory  and  never  adapted 
to  garrisons  or  camps.  The  sludge  is  always  difficult  to  dispose  of, 
while  the. liquid  effluent  contains  much  putrescible  organic  matter 
and  can  only  be  turned  into  a  water-course  of  many  times  its  volume, 
and  not  used  as  water-supply. 

BIOLOGICAL  TREATMENT. 

Fecal  matter,  as  well  as  all  forms  of  dead  organic  matter,  animal 
or  vegetable,  when  left  exposed  to  the  air,  undergo  decomposition 
and  disintegration,  and  eventually  become  reduced  to  their  primitive 
elements.  This  is  nature's  way  to  get  rid  of  offensive  decaying 
matter  and  to  transform  complex  substances,  become  useless,  into 
simple  bodies  which  can  again  be  utilized  by  growing  animals  and 
plants.  In  other  words,  nature  operates  a  conversion  of  organic  into 
mineral  substances.  This  is  effected  through  the  agency  of  bacteria 
and,  therefore,  is  a  biological  process.  This  process  is  the  result  of 
oxidation  and  is  often  designated  as  the  mineralization  or  nitrification 
of  organic  matter.  Oxidizing  or  nitrifying  bacteria  are  found  in 
great  abundance  not  only  in  excreta  but  also  in  the  upper  layers  of 
the  soil,  especially  in  the  first  3  or  4  feet,  becoming  rare  beyond  a 
depth  of  6  feet.  This  explains  why  excreta  covered  in  a  shallow 
trench  will  be  much  more  quickly  distintegrated  than  if  deeply  buried. 
These  bacteria  are  non-pathogenic,  and  broadly  divided  into  aerobic, 
or  those  unable  to  grow  without  oxygen,  and  anaerobic,  or  those 
which  grow  best  with  little  or  no  oxygen.  The  great  majority  of 
them  belong  to  the  first  division  but  both  kinds  take  an  active  part«in 
the  decomposition  and  reduction  of  organic  matter.  With  free 
access  of  air,  dead  animal  and  vegetable  substances  are  decomposed 
by  aerobic  bacteria  without  appreciable  odor.  But  as  it  is  seldom 
that  they  are  penetrated  throughout  with  a  sufficiency  of  air,  an- 
aerobic bacteria,  which  are  the  micro-organisms  of  putrefaction,  are 
also  brought  into  action  and  offensive  smells  generated. 

In  the  biological  treatment  of  sewage  disposal,  our  aim  is  to  create 
conditions  as  favorable  as  possible  to  the  growth  and  multiplication 
of  nitrifying  organisms.  This  is  often  a  difficult  problem  for  it 
involves  the  supply  to  the  organic  matter  of  one  to  three  times  its 
weight  of  oxygen  under  the  special  conditions  which  will  permit 


EXCRETA,    GARBAGE   AND    WASTES    (CONTINUED).  581 

them  to  unite.  The  first  step  in  the  process  is  the  conversion  of  the 
nitrogenous  elements  into  ammonia  (NH3)  by  the  direct  combination 
of  nitrogen  with  hydrogen.  Ammonia  by  absorbing  oxygen  becomes 
oxidized  into  nitrous  acid  (HNO2)  which,  by  further  oxidation,  is 
in  its  turn  quickly  changed  into  nitric  acid  (HNO3),  both  acids 
forming  salts  by  combining  with  calcium,  sodium  and  potassium. 
The  presence  of  these  alkalies  therefore  promotes  nitrification  and 
renders  it  more  complete.  Meanwhile  the  carbohydrates  and  fats 
are  also  attacked  by  anaerobic  bacteria,  but  much  more  slowly  de- 
composed than  nitrogenous  matters.  The  outcome  of  the  entire 
process  is  the  transformation  of  the  putrescible  excreta  into  ammonia 
and  its  salts,  nitrites  and  nitrates,  carbon  dioxid  and  water.  Thus 
there  is  rarely  as  much  as  o.oi  per  cent,  of  nitrogen  as  nitrite  or 
nitrate  in  sewage,  while  5  or  6  per  cent,  may  be  found  in  the  effluent, 
after  filtration. 

The  two  methods  by  which  the  biological  treatment  is  applied  are 
irrigation  and  filtration. 

Irrigation.  —  In  this  method  the  sewage  is  conveyed  upon  farm 
land  which  has  been  plowed  into  hills  and  furrows  and  properly 
drained.  The  irrigation  is  intermittent,  that  is,  suspended  for  a  few 
hours  every  day  in  order  that  the  air  may  freely  penetrate  into  the 
soil  and  promote  the  multiplication  of  aerobic  bacteria.  Thus  are 
fine  crops  of  vegetables  grown  near  Paris  and  Berlin,  and  there  is 
no  conclusive  evidence  that,  even  when  consumed  raw,  they  have 
ever  transmitted  disease ;  simple  prudence,  however,  requires  that 
they  should  be  carefully  washed  before  consumption.  One  acre  of 
land  will  dispose  of  the  sewage  of  from  200  to  400  persons  by  this 
method. 

Filtration.  —  Before  using  any  system  of  filtration  it  is  desirable, 
if  not  necessary,  to  apply  to  the  sewage  some  kind  of  preparatory 
treatment.  By  means  of  screening  and  settling  tanks  much  of  the 
coarser  matter  is  removed,  while  the  sludge  itself  can  be  materially 
reduced  by  the  operation  of  a  septic  tank. 

Septic  Tank.  —  In  a  septic  tank  the  sewage  is  placed  under  con- 
ditions which  favor  the  septic  process,  that  is  to  say,  the  propagation 
and  action  of  anaerobic  bacteria,  with  resulting  putrefactive  decom- 
position. The  sludge  is  broken  up,  liquefied  and,  to  some  extent, 
transformed  into  gases.  About  one-third  of  the  suspended  solids 
and  at  least  one-fourth  of  the  organic  matters  in  solution  disappear, 


582  MILITARY    HYGIENE. 

while  much  of  the  inorganic  matter  settles  to  the  bottom  or  forms  a 
scum  or  mat  on  the  surface.  The  escaping  gases  are  mostly  hydro- 
gen, nitrogen,  carbon  dioxid,  sulphureted  hydrogen,  mercaptan, 
marsh  gas  and  ammonia,  some  of  them  highly  inflammable  and 
others  with  offensive  odors. 

The  septic  tank  is  rectangular  in  shape,  five  to  eight  feet  deep. 
After  passing  through  a  settling  compartment  the  sewage  enters  the 
tank  near  the  bottom  so  as  not  to  disturb  the  surface  layer  nor  intro- 
duce much  air,  and  flows  continuously  but  very  slowly  in  order  to 
allow  the  action  of  bacteria,  as  well  as  the  rising  to  the  surface  or 
falling  to  the  bottom  of  the  decomposing  suspended  matters.  The 
capacity  of  the  tank  should  be  at  least  equal  to  one-third  of  the  daily 
amount  of  sewage  to  be  treated.  It  is  not  absolutely  necessary  to 
exclude  air  and  light,  but  desirable  that  it  should  be  covered  so  as  to 
exclude  rain  and  prevent  smells.  A  septic  tank  can  be  operated 
several  years  without  any  great  accumulation  of  scum  or  sediment. 

The  experience  acquired  in  the  operation  of  the  septic  tank,  in 
this  country,  tends  to  show  that  it  has  but  little  value  in  connection 
with  the  use  of  filter  beds,  although  still  advised  under  certain  local 
conditions  to  prevent  the  choking  of  the  beds  by  a  high  content  of 
mineral  and  indigestible  fibrous  matters.  The  conclusion  has  been 
reached  that,  on  the  whole,  the  septic  tank  has  little  to  recommend 
it, -that  there  is  no  substantial  gain  from  retaining  sewage  in  tanks 
until  decomposition  has  set  in,  but  that,  on  the  contrary,  the  practice 
is  often  distinctly  disadvantageous,  the  slightly  increased  digestion 
of  the  sludge  being  largely  counterbalanced  by  the  greater  difficulty 
of  treating  the  septic  effluent.  Simple  mechanical  sedimentation  for 
3  or  4  hours  is  preferable. 

Imhoff  Tank.  —  A  new  form  of  septic  tank  has  been  developed 
by  Imhoff,  in  Germany,  in  which  the  sludge  appears  to  be  success- 
fully disposed  of  without  altering  the  character  of  the  liquid  sewage, 
and  is  being  operated  in  this  country  with  great  satisfaction.  (Fig. 
178.)  It  consists  of  two  superposed  chambers.  Sedimentation  takes 
place  in  the  upper,  and  digestion  of  the  sludge  in  the  lower.  The 
sloping  surfaces  of  the  upper  chamber  project  over  each  other  be- 
low, leaving  a  slot  through  which  the  settled  suspended  matters  enter 
the  lower  chamber,  but  through  which  the  bubbles  of  gas  generated 
in  the  sludge  cannot  rise  into  the  upper  chamber,  so  that  the  effluent 
remains  practically  the  same  as  raw  sewage,  less  a  large  part  of  its 


EXCRETA,    GARBAGE    AND    WASTES     (CONTINUED). 


583 


suspended  solids.  At  the  bottom  of  the  lower  chamber,  under  a 
depth  of  20  to  30  feet,  the  sludge  undergoes  changes  and,  when  with- 
drawn through  the  discharge,  pipe,  appears  as  a  non-odorous,  friable, 
porous  mass,  resembling  vegetable  mold.  The  liquid  draining  from 
the  sludge  is  perfectly  clear  and  can  be  discharged  into  any  water- 


course. 


SeM/'ng  Tank  (radial do*mafd**itipv*T<l Flo*) 

4,QOO Inhabitants  (separate  system) 
SBO.ooo  U.S. gallons  daily 
Capacity  of  settling  basin  8, 60O  co.ff. 

Flowing  -through  -time  2 hours  (hourly  flow  *st<,me</*s  £  tfJaHy  flow). 
Capacity  of  sludge  -  decomposing  chamber  3.8OO  cb.fr. 


Sfoh  ftiroughwtiicti 
aWing  suspended 
nuHvy  infer  s/ucfy» 

dtcompoiingcfamtur. 


'ow  channel 


FIG.  178. —  Imhoff  tank. 


Whether  the  sewage  receives  preliminary  treatment  in  septic 
tanks  or  in  simple  sedimentation  tanks,  its  final  purification  must  be 
effected  by  submitting  it  to  the  action  of  aerobic  bacteria  by  filtra- 
tion. The  filters  used  are  sand  filters,  contact  filters  and  sprinkling 
filters. 

Sand  Filtration.  —  In  this  method  the  sewage  is  concentrated  over 
small  areas  of  specially  chosen  and  prepared  ground,  with  porous, 
thoroughly  underdrained  soil.  The  filter  is  generally  divided  into 
four  equal  parts,  each  in  turn  receiving  sewage  during  six  hours  and 
remaining  unused  during  18  hours  to  insure  the  aeration  of  the  bed 
and  the  multiplication  of  bacteria.  Sand  filtration,  largely  used  in 
America,  is  the  most  satisfactory  and  economical  method  of  sewage 
disposal  where  the  nature  of  the  soil  permits  its  use;  it  generally 


584  MILITARY    HYGIENE. 

yields  a  clear,  non-putrescible  effluent  which  may  be  turned  into  any 
stream.  One  acre  of  sand  filter  will  dispose  of  the  sewage  of  1,000 
people. 

Contact  Filter.  —  This  filter  consists  of  a  water-tight  compart- 
ment, generally  of  concrete,  filled  with  coarse  material  such  as  coke, 
clinker  or  broken  granite  with  relatively  large  interspaces.  The 
sewage  is  applied  at  regular  intervals,  left  in  contact  with  the  bed 
for  a  few  hours  and  then  slowly  drained  out.  After  each  applica- 
tion the  bed  is  allowed  a  short  rest.  Contact  beds  are  generally  dis- 
posed in  2  or  3  sets,  the  second  set  containing  smaller  filtering  mate- 
rial than  the  first,  and  the  third  than  the  second,  the  effluent  passing 
automatically  from  one  set  to  the  next.  One  acre  of  contact  beds 
will  treat  the  sewage  of  5,000  people. 

Sprinkling  Filter.  —  This  filter,  also  called  "  trickling  "  or  "  con- 
tinuous "  filter,,  represents  the  most  important  advance  of  the  last 
few  years  in  the  treatment  of  sewage.  It  consists  of  the  same  com- 
partment and  material  as  the  contact  filter,  but  is  operated  differ- 
ently. Instead  of  the  fill  and  draw,  or  intermittent,  principle,  the 
sewage  is  applied  continuously  either  as  a  spray  or  in  very  thin 
sheets  sprinkled  over  the  surface,  then  trickles  down  and  passes  out 
through  the  underdrains  which  are  comparatively  large  in  order  to 
insure  thorough  aeration  of  the  entire  bed.  The  more  subdivided 
and  broken  up  the  sewage,  the  greater  the  oxidation  and  the  better 
the  result.  Therefore  it  must  be  discharged  slowly  and  evenly  over 
the  whole  surface  of  the  bed  in  a  rain  of  fine  drops.  The  sprinklers 
may  rotate  on  an  axis,  in  which  case  circular  beds  are  used,  as  in 
England,  or  they  may  be  fixed,  in  rectangular  beds,  as  in  this  coun- 
try. Fixed  sprinklers  are  simpler,  cheaper,  more  easily  operated 
and  less  affected  by  frost.  Highly  recommended  is  the  use  of 
splashing  disks  or  concave  disks  into  which  the  sewage  is  discharged 
from  the  bottom  of  a  trough  and  from  which  it  is  projected  in  a 
fine  circular  spray.  Sprinkling  filters  may  run  10  to  15  years  before 
the  material  becomes  clogged  and  requires  renewal.  They  yield  a 
higher  degree  of  purification  than  contact  filters  and  their  rate  of 
treatment  is  about  four  times  as  great,  one  acre  of  sprinkling  beds 
being  able  to  dispose  of  the  sewage  of  20,000  people.  The  effluent 
is  not  quite  as  good  as  that  obtained  from  intermittent  sand  filtra- 
tion; it  still  contains  more  than  one-half  of  the  soluble  organic  mat- 
ter of  the  sewage  and  is  more  or  less  turbid,  but  it  is  non-putrescible, 


EXCRETA,    GARBAGE    AND    WASTES    (CONTINUED).  585 

stable  and  fit  to  be  discharged  into  almost  any  stream  not  used  as 
water-supply. 

Although  the  organic  matter  in  the  effluent  of  the  contact  or 
sprinkling  filter  is  not  completely  nitrified,  its  chemical  composition 
has  been  so  altered  in  the  process  that,  as  a  rule,  it  is  no  longer 
putrescible. 

Combined  Method.  —  The  ideal  method  of  sewage  disposal,  such 
as  is  used  at  Lawrence,  Mass.,  consists  in  preliminary  sedimentation 
followed  by  sprinkling  beds  and  sand  filtration.  The  effluent  thus 
obtained  is  practically  pure  and  may  be  safely  allowed  to  run  into 
any  water-supply. 

Stability  of  Effluent.  —  An  effluent  is  said  to  be  stable  when  its 
organic  matter  has  been  so  transformed  during  filtration  that  it  is 
incapable  of  undergoing  offensive  putrefactive  decomposition;  it  is 
that  condition  in  which  the  available  oxygen  (in  solution  or  as 
nitrites  and  nitrates)  equals  or  exceeds  the  oxygen  required  to  allow 
nitrification  to  proceed  on  to  completion. 

Immediately  after  the  complete  exhaustion  of  the  oxygen  in  sew- 
age, anaerobic  fermentation  (putrefactive  decomposition)  begins, 
with  production  of  hydrogen  sulphide.  The  property  of  this  gas 
to  discolor  methylene  blue  furnishes  a  simple  test  to  determine  the 
stability  of  an  effluent.  The  sample  to  be  tested  is  collected  in  a  200 
c.  c.  glass-stoppered  bottle.  One-half  c.  c.  of  a  one-tenth  per  cent, 
of  methylene  blue  is  added  to  the  sample  which  is  then  incubated 
at  20°  C.  for  four  days.  If  it  remains  blue  at  the  end  of  that  time, 
it  contains  enough  available  oxygen  to  prevent  its  becoming  putres- 
cible and  a  nuisance.  When  an  effluent  is  discharged  into  a  bay 
or  large  river  where  it  is  highly  diluted  and  freely  oxygenated,  the 
same  degree  of  stability  is  not  necessary.  The  least  that  can  be  re- 
quired of  waters  not  used  for  drinking  purposes  is  that  the  sewage 
discharged  into  them  should  not  interfere  with  fish  life.  Such  in- 
terference occurs  whenever  the  dissolved  oxygen  falls  below  70  per 
cent,  of  its  original  amount.  Many  of  our  bays  and  rivers  do  not 
come  up  to  this  standard. 

DISINFECTION    OF    SEWAGE    EFFLUENTS. 

A  considerable  proportion  of  sewage  bacteria  is  removed  by  the 
operation  of  the  septic  tank  and  of  the  contact  and  sprinkling  fil- 
ters, but  this  removal  is  not  sufficiently  complete  to  have  much  sani- 


586  MILITARY    HYGIENE. 

tary  significance.  Enough  micro-organisms  remain  in  effluents  to 
render  them  highly  suspicious,  frequently  containing  nearly  as 
many  colon  bacilli,  spores  of  Bacillus  enteritidis  sporogenes  and 
Streptococci  as  the  crude  sewage.  For  this  reason  untreated  efflu- 
ents should  not  be  discharged  into  streams  used  for  water-supply, 
or  bays  in  which  are  oyster  beds  or  other  shell-fish.  Slow  sand 
filtration  almost  totally  eliminates'  the  organic  matter  and  yields 
an  effluent  practically  free  from  pathogenic  bacteria,  but  is  a  costly 
method,  seldom  applicable.  Simple  sedimentation  improves  a  very 
turbid  effluent  but  does  not  make  it  bacterially  safe.  Chemical 
disinfection  offers  a  simple  means  to  produce  a  sufficient  and  satis- 
factory bacterial  purification,  even  without  the  complete  oxidation 
of  the  organic  matter.  As  a  finishing  process  it  can  be  conducted 
at  far  less  cost  than  the  cheapest  form  of  supplementary  sand 
filtration.  Chlorine  is  the  most  efficient  agent  for  the  purpose,  in 
the  form  of  calcium  hypochlorite  or  the  commercial  bleaching 
powder,  in  the  amount  of  3  to  5  parts  of  available  chlorine  per 
million  parts  of  effluent.  The  removal  of  bacteria  averages  over 
95  per  cent.,  corresponding  to  98  or  99  per  cent,  in  the  crude  sewage, 
at  a  cost  of  i  to  1.50  dollars  per  million  gallons.  The  pathogenic 
bacteria  are  all  destroyed;  the  organisms  that  survive  are  chiefly 
of  the  nitrifying  and  spore-bearing  kinds.  The  bacterial  purifica- 
tion of  the  crude  sewage  itself  can  be  accomplished  by  increasing 
the  dosage  of  available  chlorine  to  from  5  to  10  parts  per  million 
of  sewage.  Gaseous  chlorine,  found  more  efficient  than  any  of  its 
compounds  in  water  purification,  can  probably  be  also  successfully 
applied  to  sewage. 

DISPOSAL   IN   GARRISON   AND   CAMP. 

The  disposal  of  human  excreta  is  one  of  the  most  important  prob- 
lems that  confront  the  military  hygienist,  one  that  should  be  the 
object  of  the  constant  solicitude  of  the  medical  officer  and  require 
his  most  careful  attention.  All  our  military  posts,  with  few  excep- 
tions, are  provided  with  modern  water-closets  and  sewerage,  and 
their  excreta  and  wastes,  after  or  without  previous  treatment,  car-* 
ried  away  to  the  sea,  neighboring  lakes  or  streams.  Other  systems 
more  or  less  applicable  to  permanent  stations  are  described  under 
Camps.  The  use  of  the  primitive  pit-privy  at  a  post,  cantonment 
or  permanent  camp  could  only  be  justified  by  very  exceptional 
conditions. 


EXCRETA,    GARBAGE   AND    WASTES    (CONTINUED).  587 

The  method  adopted  for  some  of  our  largest  interior  posts  is  in 
conformity  with  the  highest  modern  standards,  except  that  contact 
beds  are  used  instead  of  the  more  expensive  sprinkling  filters.  The 
sewage  plant  at  Fort  Benjamin  Harrison,  Ind.,  (Fig.  179)  has  a 
maximum  capacity  of  200,000  gallons  in  24  hours.  It  does  not 
receive  surface  or  storm  water.  The  degree  of  purification  required 
by  the  Q.  M.  Corps  is  that  all  solid  matters  will  be  arrested, 
and  80  per  cent,  destroyed ;  that  the  effluent  shall  not  contain  more 
that  1.50  parts  of  albuminoid  ammonia  in  1,000,000  parts,  and  that 
1,000,000  parts  shall  consume  less  than  15  parts  of  oxygen  in  4 
hours ;  that  the  effluent  shall  be  clear,  colorless,  odorless,  non-putres- 
cible,  and  free  from  typhoid  and  other  pathogenic  germs. 

The  plant  consists  of  five  tanks,  two  sets  of  contact  beds  and  one 
sand  filter,  all  built  of  concrete  and  lined  with  a  coat  of  cement 
plastering  one-half  inch  thick.  The  tanks  are  a  grit  tank  or  sedi- 
ment chamber,  three  septic  tanks  and  a  dosing  tank,  all  covered 
over,  with  roof  properly  ventilated  and  a  sufficient  number  of  man- 
holes. The  grit  chamber  receives  the  raw  sewage  and  retains  all 
heavy  insoluble  matter;  it  has  submerged  openings,  guarded  with 
slide  gates,  one  into  each  septic  tank,  and  a  drain-pipe  connected 
with  the  by-pass  drain.  The  three  septic  tanks  are  each  of  suffi- 
cient size  to  give  treatment  to  67,000  gallons  of  sewage  in  24  hours. 
A  baffle  wall,  in  each  tank,  serves  to  scatter  the  sewage  as  it  enters 
from  the  grit  chamber.  From  the  septic  tanks  the  effluent  is  dis- 
charged into  the  dosing  tank  by  a  submerged  weir  so  placed  as  not 
to  disturb  the  mat  or  scum  formed  on  the  surface.  Each  tank  is 
provided  with  a  drain  so  that  the  sludge  may  be  removed  into  the 
by-pass  drain  without  disturbing  the  surface  mat.  The  dosing  tank 
collects  the  effluent  until  it  has  enough  to  charge  one  contact  bed, 
and  then  discharges  it  onto  the  bed  by  an  automatic  alternating 
device. 

Each  set  of  contact  beds  consists  of  three  beds,  each  bed  of  such 
capacity  that  the  time  consumed  between  doses,  that  is  to  say,  in 
filling,  resting  full,  emptying  and  aerating,  shall  be  no  less  than  6 
nor  more  than  8  hours.  The  effluent  is  distributed  over  the  surface 
of  the  beds  by  open-joint  vitrified  pipes,  and  collected  at  the  bottom 
by  horseshoe-tile  pipes,  being  discharged  from  the  beds  of  the  first 
set  to  those  of  the  second  by  an  automatic-timed  device,  and  finally 
upon  the  sand  filter. 


588 


MILITARY    HYGIENE. 


HfLlU  snonNiiNpo 

aaa  H3-L1IJ  c 

ii 

FIG.  179. —  Sewage  purification  plant.     Fort  Benjamin  Harrison,  Indiana. 


EXCRETA,    GARBAGE   AND    WASTES    (CONTINUED). 


589 


The  filling  material  of  the  beds,  4  feet  deep,  is  of  good,  hard, 
broken  stones  or  pebbles,  capable  of  resisting  the  alternate  action 
of  water,  air  and  frost  without  dissolving  or  disintegrating.  In 
size  it  ranges  from  I  to  2  inches  in  diameter  at  the  bottom ;  decreas- 
ing to  J/2  inch  at  top  in  the  first  set,  and  to  l/%  inch  in  the  second  set. 

LOCAL   OR  DOMESTIC  TREATMENT. 

In  the  absence  of  a  general  or  central  system  of  sewerage,  various 
methods  may  be  resorted  to  for  the  disposal  of  excreta  and  wastes. 
Ordinary  vaults  are  still  used  in  many  communities  although  rarely 
at  military  posts.  They  should  be  lined  with  stone  or  brick  and 
cemented  so  as  to  be  water-tight  and  not  endanger  neighboring 
water-supplies.  The  water-closets  may  empty  directly  into'  them, 
or  else  by  means  of  soil  pipes  and  drains.  Inasmuch  as  these  vaults 
have  to  be  periodically  emptied,  it  is  evident  that  they  are  only  a 


FIG.  180. —  Mouras  vault. 

poor  makeshift  and  not  a  final  means  of  disposal.  The  contents 
can  be  spread  on  and  plowed  into  tillable  land  with  safety,  and 
benefit  to  the  soil.  The  addition  of  lime  is  useful,  acting  as  deodor- 
ant and  disinfectant  and  generally  increasing  the  fertility  of  the  soil ; 
it  is  especially  advisable  when  the  contents  are  thrown  over  the 
frozen  ground. 

An  improvement  upon  the  ordinary  vault  is  the  Mouras  vault 
used  with  various  degrees  of  success  in  many  countries.  In  this 
system  a  notable  amount  of  septic  decomposition  takes  place,  per- 
haps also  a  certain  degree  of  nitrification,  so  that  the  overflow  may 


590 


MILITARY    HYGIENE. 


be  allowed  to  run  into  a  large  stream  or  upon  a  field  for  Irrigation 
purposes.  As  seen  in  Fig.  180,  this  vault  consists  of  two  unequal 
compartments  connected  by  means  of  a  curved  pipe;  the  soil-pipe 
C  dips  in  the  liquid  contents  of  the  larger  compartment;  as  these 
contents  rise  they  pass  into  the  smaller  compartment  and  thence 


FIG.  181. —  Sub-surface  irrigation.    Waring  system. 


EXCRETA,  GARBAGE  AND  WASTES  (CONTINUED).        59! 

siphon  into  the  outlet.  The  small  pipe  A,  intended  to  relieve  the 
pressure  of  gases,  is  of  doubtful  utility. 

SUB-SURFACE  IRRIGATION.  —  For  small  institutions,  country 
houses,  military  posts  or  camps,  not  exceeding  100  persons,  the 
Waring  system  of  sub-surface  irrigation  is  available  (Fig.  181). 
It  consists  of :  i,  two  masonry  tanks,  under  ground,  either  circular 
or  rectangular,  arched  over  and  fitted  with  manhole  covers,  the 
larger  for  the  settling  and  liquefying  of  the  organic  solids,  the 
smaller  or  flush-tank,  to  receive  and  hold  the  liquefied  sewage  until 
the  required  quantity  has  accumulated,  and  then  discharge  it  by 
means  of  an  automatic  siphon ;  2,  a  gate  chamber  to  permit  divert- 
ing the  discharged  sewage  from  one  place  of  disposal  to  another; 
3,  lines  of  open-jointed  disposal  tiles  to  distribute  the  sewage  into 
the  soil  surrounding  them,  below  the  surface  of  the  ground. 

The  sewer  is  trapped  where  it  enters  the  tank  and  ventilated  by 
a  pipe  extending  above  ground.  The  tank  itself  is  not  ventilated. 
The  discharge  by  the  siphon  being  intermittent  and  uniform,  the 
soil  never  receives  more  sewage  than  it  is  capable  of  absorbing  and 
oxidizing.  The  disposal  tiles  are  as  near  the  surface  as  protection 
from  breakage  will  permit,  so  as  to  favor  the  bacterial  work  of 
nitrification;  experience  having  proved  that  even  the  severe  winter 
weather  of  New  England  has  no  appreciable  injurious  effects  upon 
their  efficiency. 

Without  departing  from  the  principles  upon  which  this  system 
is  based,  simple  modifications  applicable  to  various  conditions  will 
suggest  themselves.  For  instance,  where  the  amount  of  sewage  is 
relatively  small,  one  tank  will  probably  answer  the  purpose.  A 
simple  and  cheap  improvisation  would  consist  of  a  barrel  as  settling 
tank,  a  half  barrel  as  flush  tank  with  pipe  curved  into  a  siphon  for 
the  intermittent  discharge  of  the  sewage  into  a  line  of  sub-surface 
tiles.  .  The  siphon  is  not  essential  and,  where  the  tiles  are  ample, 
can  be  dispensed  with. 

THE     LUMSDEN,     ROBERTS     AND     STILES     SANITARY     PRIVY.         (Public 

Health  Service.) 

This  type  of  the  "  wet  system  "  admits  of  ready  improvisation 
and  is  principally  intended  for  rural  households  (Fig.  182).  It 
consists  of :  a  water-tight  tank  or  barrel  as  liquefier ;  a  smaller  bar- 
rel, can  or  kettle  to  receive  the  effluent ;  a  connecting  pipe  of  which 


592 


MILITARY    HYGIENE. 


the  end  dipping  in  the  tank  is  covered  with  wire  gauze ;  a  tight  box 
set  on  the  tank,  with  opening  on  top  for  the  seat,  and  self-closing 
lid;  an  anti-splashing  device  consisting  of  a  small  board  placed 
horizontally  about  an  inch  below  the  surface  of  the  water,  and 
which  can  be  raised  and  lowered  by  means  of  a  rod. 

The  liquefying  tank  is  filled  with  water  up  to  the  point  where 
it  begins  to  trickle  into  the  effluent  receptacle,,  through  the  connect- 
ing pipe.  The  fecal  matter  falls  into  the  water  but  the  board  pre- 
vents splashing  and  thus  meets  one  of  the  greatest  objections  raised 
against  the  wet  system.  After  defecation  the  board  is  depressed 
to  let  the  fecal  matter  float  free  in  the  water  where  it  undergoes 
a  certain  degree  of  fermentation  and  liquefaction.  The  effluent  can 
be  used  as  fertilizer,  but  if  suspected  of  infection  by  pathogenic 
germs,  should  previously  be  boiled  or  mixed  with  chloride  of  lime, 


Conne.c.+mq 


FIG.   182. —  Improved  L.  R.   S.  privy.     Public  Health   Service. 


EXCRETA,    GARI5AGE    AND    WASTES    (CONTINUED).  593 

one-fourth  of  a  pound  to  the  gallon  of  liquid,  or  again  may  be  car- 
ried away  by  an  underground  drain  as  in  the  preceding  system. 

The  tank  may  be  constructed  of  sufficient  length  to  accommodate 
two  or  more  seats,  each  seat  with  its  corresponding  splashing 
board. 

This  privy  should  be  in  a  fly-proof  and  well-ventilated  shed,  and, 
when  properly  operated,  is  practically  odorless. 

Whenever  a  satisfactory  system  of  sewerage  is  impracticable  at 
a  post  or  cantonment,  for  instance  where  the  weather  is  too  cold 
for  water-closets,  one  of  the  methods  of  disposal  described  under 
Camps  may  be  used,  especially  the  earth-closet,  milk-of-lime  closet 
or,  still  better,  one  of  the  incinerators. 

DISPOSAL    OF   GARBAGE. 

Garbage  and  all  waste  material,  to  be  properly  disposed  of,  at 
posts  as  well  as  in  cities,  must  be  sorted  and  divided  according  to 
their  composition.  Kitchen  wastes,  for  instance,  which  contain  a 
large  proportion  of  putrescible  and  dangerous  organic  matter,  should 
be  separated  from  dry  refuse  and  ashes.  At  least  two  cans  are 
required,  but  three  are  still  better,  one  for  kitchen  and  liquid  wastes, 
a  second  for  ashes  and  other  dry  non-combustible  matter,  and  a 
third  for  combustible  refuse.  The  receptacles  should  be  of  galvan- 
ized iron,  air-tight  and  fitted  with  lids  to  exclude  flies  and  prevent 
odors.  Moisture  is  the  immediate  cause  of  the  fermenting  and 
smell  of  garbage,  therefore  the  drier  the  latter  is  the  longer  it  can 
be  kept  without  being  a  nuisance.  An  excellent  device  where 
kitchen  garbage  cannot  be  emptied  every  day  is  to  drain  it  and 
then  wrap  it  up  in  paper  before  putting  it  in  the  can.  In  this  state 
it  does  not  smell  bad  in  hot  weather,  nor  freeze  and  stick  to  the  can 
in  cold  weather;  the  can  remains  clean  and  need  not  be  emptied 
more  than  once  or  twice  a  week. 

In  cities,  at  least  three-fourths  of  the  dry  refuse  has  a  salable 
value.  From  the  kitchen  garbage  a  notable  proportion  of  oil  can 
be  obtained,  while  the  residue  is  utilized  as  fuel.  At  military  posts, 
such  economic  disposal  is  impracticable.  The  rule  has  been,  in  the 
absence  of  crematories,  to  feed  the  kitchen  garbage  to  pigs  or  pour 
it  into  pits,  and  to  throw  all  other  refuse  and  wastes  on  the  dump. 
The  latter  is  incinerated  so  far  as  it  is  practicable,  generally  very 
imperfectly. 


594 


MILITARY    HYGIENE. 


Such  primitive  method  should  no  longer  be  countenanced  at  any 
of  our  garrisons  or  camps.  The  only  proper  way  to  dispose  of 
garbage  and  all  other  combustible  refuse  is  by  fire,  and  it  is  always 
possible,  in  all  places,  to  improvise  an  efficient  "  rock  pile  crema- 
tory "  (see  page  672).  Most  of  our  large  posts  are  now  supplied 
with  regular  grate  crematories.  These  are  of  various  kinds.  It 
is  generally  stipulated  that  they  shall  be  of  a  capacity  of  not  less 
than  two  tons  per  hour,  or  sixteen  tons  per  day  of  eight  hours,  arid 
so  constructed  as  to  consume  manure,  garbage  and  liquids ;  in  other 
words,  all  wastes.  It  is  especially  necessary  to  fire  empty  tin  cans ; 
they  always  contain  organic  matter  adhering  to  their  walls  and  are 
favorable  media  for  the  multiplication  of  all  sorts  of  bacteria  until 
thoroughly  burned  out. 

One  of  the  latest  and  best  types  of  crematories  is  illustrated  in 
Figs.  183  and  184.  The  building  is  of  wood,  covered  on  sides  and 
roof  with  corrugated  sheet  steel,  and  resting  on  brick  or  stone  walls 
and  piers  with  concrete  footings ;  the  floor  is  of  concrete.  The 
doors,  of  corrugated  sheet  steel,  are  of  the  rolling  pattern.  When 
this  building  is  erected  upon  a  side-hill  the  runway  and  platform 
are  omitted,  but  a  longitudinal  stone  retaining  wall  is  necessary. 


FIG.  183. —  Crematory  building  —  Fort  D.  A.  Russell,  Wyo. 


EXCRETA,    GARBAGE   AND    WASTES    (CONTINUED).  595 

The  apparatus  (Fig.  184)  consists  essentially  of  a  fire-clay  garbage 
platform  above,  and  of  five  cast-iron  fire  grates  below,  namely,  two 
on  each  side  for  incineration  and  a  central  one  to  strengthen  the 
draft  and  complete  the  combustion  of  gases.  The  garbage  being 
spread  upon  the  platform,  fires  are  started  in  the  grates  A  A  and  C. 
and  the  damper  D  closed.  The  heat  and  smoke  current  passes 
through  and  over  the  garbage  and  then  under  the  platform  on  its 
way  to  the  smokestack.  The  garbage,  being  sufficiently  dried  on 
the  left  half  of  the  platform,  is  thrown  upon  the  grates  A  A  to  serve 
as  fuel.  When  the  garbage  on  that  end  of  the  platform  has  been 
disposed  of,  the  damper  D  is  opened  and  damper  E  closed,  and  fires 
started  in  the  grates  B  B?  thus  reversing  the  heat  current  and  re- 
peating the  same  process  on  the  right  end  of  the  platform ;  fresh 
garbage  being  dumped  on  meanwhile  so  as  to  keep  the  platform  al- 
ways supplied. 


596 


MILITARY    HYGIENE. 


FIG.   184.— Crematory  grates  —  Fort  D.  A.  Russell,  Wyo 


CHAPTER  XLVIII. 
SOIL. 

Soil  is  a  mixture  of  mineral  substances,  chiefly  sand,  clay  and 
limestone,  with  more  or  less  organic  matter.  Its  principal  mineral 
constituents  are:  silica  (quartz,  sand,  sandstone,  etc.)  which  forms 
more  than  half  of  the  earth's  crust;  aluminum,  mostly  as  clay  (sili- 
cate of  aluminum)  ;  lime  as  carbonate  (limestone),  phosphate  and 
sulphate ;  and  magnesia  as  carbonate  and  sulphate.  Other  constant 
but  secondary  constituents  are ;  iron  and  manganese,  the  former 
playing  a  very  important  part  in  the  growth  of  plants ;  chlorine  as 
chloride  of  sodium  and  potassium ;  sulphur  as  sulphides  and  sul- 
phates; phosphorus  as  phosphates. 

The  vegetable  mould  generally  present  in  the  soil  and  forming  the 
bulk  of  its  organic  matter,  is  called  humus,  a  very  complex  substance 
particularly  rich  in  nitrogen  and  therefore  characteristic  of  fertile 
land.  Peat  and  muck  result  from  the  incomplete  decay  of  vegetable 
matter  under  water,  the  former  being  more  compact  and  fibrous 
than  the  latter.  Nitrogen  exists  in  the  organic  matter  not  yet  de- 
composed, as  well  as  in  the  products  of  its  decomposition,  namely 
ammonia  and  its  salts,  nitrites  and  nitrates. 

PHYSICAL  PROPERTIES  OF  SOILS. 

All  soils  are  porous  to  air.  This  porosity  does  not  depend  so 
much  upon  the  size  of  the  individual  particles  of  earth  as  upon 
their  shape  and  arrangement.  The  total  volume  of  the  interstices 
or  pores  between  the  grains,  amounts  to  about  35  per  cent,  of  the 
entire  mass  in  ordinary  soils;  even  the  most  compact  rocks  have 
more  or  less  porosity  although  impervious  to  water.  The  per- 
meability of  soils  to  air  is  not  necessarily  proportional  to  their 
porosity,  but  depends  chiefly  upon  the  size  of  the  pores;  as  these 
grow  larger,  permeability  increases,  although  the  volume  of  porosity 
tends  to  decrease;  thus  the  permeability  of  medium  gravel  is  more 
than  100  times  greater  than  that  of  medium  sand  although  its  total 
porosity  is  less.  Clay,  consisting  of  exceedingly  fine  adhesive  par- 
ticles, possesses  but  little  permeability,  unless  fissured  or  crumbly 

597 


598  MILITARY    HYGIENE. 

or  mixed  with  sand  or  chalk.  The  degree  of  permeability  of  any 
soil  to  air  is  greatly  influenced  by  the  amount  of  contained  moisture ; 
water  drives  out  the  air  and  may  render  the  soil,  especially  if  largely 
composed  of  clay  or  peat,  completely  impervious  to  it. 

Ground  Air.  —  Ground  air  differs  from  atmospheric  air  in  its 
much  greater  proportion  of  carbon  dioxid;  it  is  also  somewhat 
richer  in  ammonia  and  occasionally  contains  sulphureted  and  car- 
bureted hydrogen.  All  these  gases  result  from  the  oxidation  of 
the  organic  matter  in  the  soil  where,  therefore,  the  air  suffers  a 
corresponding  loss  of  oxygen.  The  amount  of  carbon  dioxid  varies 
much  according  to  the  nature  of  the  ground  and  the  depth  from 
the  surface.  A  soil  rich  in  organic  matter  evolves  a  great  deal 
more  of  it  than  if  mainly  composed  of  sand  or  chalk;  likewise,  more 
is  generated  in  summer,  when  decomposition  is  active,  than  in  cold 
weather.  At  a  depth  of  one  meter  the  amount  of  carbon  dioxid 
is  seldom  less  than  5  parts  per  1,000  of  air  and  may  reach  15  or  20 
parts,  while  at  a  depth  of  4  meters  it  is  two  or  three  times  as  much. 
Ground  air  is  not  immobilized  in  the  soil ;  on  the  contrary,  owing 
to  differences  of  temperature  between  it  and  the  atmospheric  air, 
winds,  rise  and  fall  of  subsoil  water,  etc.,  it  is  always  in  motion, 
constantly  displaced,  renewed  and  mixed  with  outside  air,  so  that 
the  atmospheric  layers  nearest  the  ground  are  always  more  or  less 
contaminated  with  it.  The  teaching  of  Pettenkofer  that  the  amount 
of  carbon  dioxid  in  any  part  of  the  soil  is  an  index  of  the  amount  of 
organic  matter  present  is  obviously  erroneous,  since,  on  account  of 
the  permeability  and  ventilation  of  the  soil,  the  gas  found  in  one 
place  may  easily  have  been  generated  at  some  other  place. 

When  the  surface  is  impermeable,  as  by  freezing,  or  when 
cemented,  tiled  or  macadamized,  the  ground  gases  may  traverse 
long  lateral  distances ;  in  this  way  air  from  cesspools,  broken  drains, 
gas,  buried  garbage,  etc.,  may  be  drawn  into  cellars  and  escape,  by 
upward  draft  of  air,  into  heated  dwellings. 

Ground  Moisture.  —  Water  is  retained  in  the  ground  by  two 
forces:  molecular  adhesion,  that  is,  the  .attraction  of  the  surfaces 
of  soil  grains  for  liquids,  and  capillary  attraction.  The  latter  force 
is  active  only  when  the  pores  or  interstices  are  sufficiently  small 
(less  than  a  millimeter).  This  capillary  water  forms  the  great  bulk 
of  the  retained  moisture;  it  is  the  more  abundant  that  the  texture 
of  the  ground  is  closer  and  more  compact ;  thus  a  soil  with  grains 


SOIL.  599 

half  a  millimeter  in  diameter  will  hold  nearly  three  times  as  much 
water  as  one  with  grains  2  mm.  in  diameter.  Sand,  with  its  rela- 
tively large  pores,  absorbs  but  little  water,  chalks  absorbs  a  good 
deal  more,  while  clay  retains  from  70  to  80  per  cent,  of  its  weight. 
'Organic  matter  is  very  absorbent  of  water,  humus  being  capable 
of  retaining  several  times  its  weight  of  it.  Permeability  of  the 
ground  to  water,  as  to  air,  depends  upon  the  size  of  the  pores,  and 
therefore  is  generally  inversely  proportional  to  capillarity  or  the 
capacity  of  water  retention.  Thus  sand  is  freely  permeable,  that 
is,  permfts  a  rapid  percolation  of  water;  chalk  is  less  so,  while  clay 
may  be  totally  impermeable.  Even  marls  (mixtures  of  chalk  and 
clay)  not  containing  more  than  40  or  50  per  cent,  of  clay,  are  some- 
times quite  impervious.  Rocks  vary  greatly  in  this  respect,  those 
of  volcanic  origin  being  absolutely  impervious,  while  sandstones 
and  limestones  are  quite  porous  and  generally  allow  more  or  less 
nitration. 

Rain-water  percolates  through  the  soil  and  subsoil  until  it  reaches 
an  impermeable  stratum,  either  clay  or  rock,  upon  which  it  collects 
to  a  variable  depth.  This  ground  water  furnishes  more  or  less 
moisture  to  the  subsoil  through  capillary  attraction  and  much  of  it 
is  evaporated  through  the  soil.  It  is  in  constant  motion,  the  direc- 
tion of  the  flow  depending  necessarily  upon  the  slope  of  the  im- 
permeable stratum  below,  but  this  slope  cannot  always  be  inferred 
from  that  of  the  soil  surface.  The  trend  of  this  ground  water 
may  generally  be  assumed  to  be  toward  the  nearest  watercourse 
below  it,  but  often  the  only  way  to  ascertain  it,  as  well  as  the  depth 
of  the  water  level,  will  be  by  the  digging  of  a  series  of  wells.  The 
rise  and  fall  of  the  ground  water  depends  chiefly  upon  the  rainfall, 
but  it  is  materially  influenced  by  the  extent  of  vegetation,  especially 
woodlands,  the  rate  of  evaporation,  and  the  amount  drawn  for  the 
supply  of  neighboring  communities. 

The  effects  of  constant 'humidity  upon  the  human  organism  are 
decidedly  pernicious,  probably  through  its  interference  with  the 
functions  of  the  skin  and  the  evaporation  from  the  lungs.  Long 
ago,  Dr.  H.  I.  Bowditch  stated  that  "  A  residence  on  or  near  a  damp 
soil  is  one  of  the  primal  causes  of  consumption  in  Massachusetts, 
probably  in  New  England." 

Ground  Temperature.  —  The  soil  being  a  bad  conductor  of  heat, 
changes  in  the  temperature  of  the  air  are  less,  and  more  slowly,  felt 


6OO  MILITARY    HYGIENE. 

a  few  feet,  or  even  a  few  inches,  beneath  its  surface ;  thus  a  cave, 
cellar  or  dugout  is  cooler  in  summer  and  warmer  in  winter  than 
the  outside  air.  The  power  of  the  soil  to  absorb  solar  heat  depends 
mostly  upon  color,  black  absorbing  much  more  than  lighter  shades, 
and  white  sand  least.  The  power  of  emission  or  radiation  is  pro- 
portional to  that  of  absorption,  thus  dark  soil  loses  more  heat  at 
night  than  chalk  or  sand.  Snow,  being  also  a  poor  heat  conductor, 
protects  winter  crops  from  extreme  cold.  A  hole  dug  in  a  snow 
drift,  or  shelter  built  of  snow,  may  save  soldiers  or  travelers  from 
death  by  congelation.  The  specific  heat  of  water  being  about  four 
times  that  of  air  and  of  most  mineral  substances,  it  follows  that 
water  is  not  so  readily  affected  by  heat  and  maintains  a  much  more 
equable  temperature  than  air  or  soil ;  moist  soil,  therefore,  absorbs 
heat  more  slowly  than  dry  soil  and  its  temperature  does  not  rise 
to  the  same  degree.  For  instance,  the  heat  that  would  raise  the 
temperature  of  sand  6.67°  F.,  and  of  weathered  granite  3.33°,  will 
only  raise  that  of  water  one  degree.  It  is  chiefly  by  its  evapora- 
tion, however,  that  moisture  lowers  the  ground  temperature,  for 
this  evaporation  is  always  at  the  expense  of  the  heat  of  contiguous 
solid  substances. 

In  practice,  the  color  of  soils  does  not  vary  sufficiently  to  make 
much  difference  in  heat  absorption.  The  warming  of  the  soil,  as 
above  noted,  depends  chiefly  upon  the  amount  of  moisture  it  retains. 
Thus  a  sandy,  well-drained  soil,  although  light  in  color  will  warm 
much  faster  than  a  wet  and  heavy  soil,  although  dark  in  color.  This 
is  to  be  remembered  in  the  selection  of  camping  grounds. 

Influence  of  Vegetation  on  Soil.  —  Plants,  but  especially  trees 
whose  enormous  system  of  roots  extends  many  yards  in  all  direc- 
tions, absorb  large  amounts  of  moisture  and  tend  to  dry  a  damp 
soil ;  thus  most  trees  evaporate  through  their  foliage  a  total  of 
moisture  several  times  greater  than  the  amount  of  rain  and  snow 
falling  upon  the  area  they  cover;  hence  the  wisdom  of  planting 
quick-growing  trees  with  abundant  foliage  in  marshy  lands,  and 
to  keep  these  clear  of  underbrush.  On  the  other  hand,  woodlands 
have  a  marked  effect  in  retaining  rain-water  and  regulating  its  pene- 
tration of  the  soil.  The  leaves  become  so  many  receptacles  from 
which  the  raindrops,  forming  tiny  streamlets,  flow  down  the  stalks 
and  branches  to  the  trunk,  and  continue  to  reach  the  ground  long 
after  the  rain  has  ceased,  thus  preventing  any  sudden  flooding.  But 


SOIL.  60 1 

the  water  is  also  entangled  and  arrested  by  the  compost  of  vege- 
table matter,  together  with  the  litter  of  foliage  and  twigs  which 
cover  the  forest  soil,  and  therefore  more  of  it  penetrates  the  soil 
and  is  utilized.  The  remainder  runs  out  in  brooklets  which  keep 
the  outflowing  streams  evenly  and  constantly  fed.  It  has  not  been 
proved  that  the  removal  of  forests  materially  decreases  the  rain- 
fall in  any  region,  but  it  is  certain  that  it  brings  about  the  loss  of  a 
large  proportion  of  it;  the  water,  not  being  arrested  by  the  foliage 
nor  retained  by  the  soil  compost  or  litter,  rushes  off  into  the  nearest 
water-courses,  causing  sudden  freshets  and  destructive  torrents. 
Vegetation  tends  to  equalize  the  temperature  of  the  soil,  absorbing 
less  heat  during  the  day  and  retaining  more  during  the  night. 
"  Herbage  acts  as  a  protection  against  excessive  heating  in  hot 
climates,  and  as  a  blanket  to  prevent  loss  of  heat  in  cold  ones  " 
(Harrington). 

POLLUTION   AND  SOIL  BACTERIA. 

The  soil  is  the  great  receptacle  in  which  all  the  organic  filth  not 
directly  carried  to  the  ocean  is  deposited,  and  therefore  would  soon 
become  hopelessly  polluted  were  it  not  for  the  provisions  made  by 
nature  to  maintain  a  safe  equilibrium  between  dead  organic  matter 
and  living  animals  and  plants.  Nature's  scavengers  are  the  micro- 
organisms or  bacteria  of  the  soil.  The  ground  is  full  of  them,  from 
several  thousands  to  several  millions  per  cubic  centimeter.  As  they 
feed  and  multiply  on  organic  matter,  the  more  there  is  of  it,  that 
is  the  richer  is  the  soil,  the  more  abundant  they  are.  Other  favor- 
able conditions  to  their  growth  are  a  certain  degree  of  heat  and 
some  moisture.  These  bacteria,  as  already  stated,  are  found  mostly 
in  the  upper  layers,  especially  in  the  first  four  feet,  below  which 
they  diminish  rapidly  so  that  few  are  found  beyond  a  depth  of  10 
or  12  feet.  These  soil  microbes  consist  mainly  of  beneficent  aerobic 
saprophytes.  Their  chief  and  most  important  function  is  the  de- 
composition of  all  dead  organic  matter,  animal  and  vegetable,  and 
its  transformation  into  simple,  assimilable  elements  which  are  again 
available  for  growing  animals  and  plants.  Among  them  may  be 
noted  the  "  nitrifying "  and  "  denitrifying "  bacteria,  the  former 
bringing  about  an  oxidation  of  ammonia  into  nitrites  and  nitrates, 
while  the  latter  decompose  nitrogenous  matter  into  its  constituent 
elements.  Another  useful  office  which  they  perform,  through  their 


6O2  MILITARY    HYGIENE. 

competition  and  greater  power  of  resistance,  is  the  prevention  of 
the  growth  and  multiplication  of  pathogenic  bacteria.  The  latter 
are  more  delicate  organisms;  only  four  are  commonly  found  in  the 
earth  and  able  to  perpetuate  themselves,  the  bacilli  of  tetanus,  of 
anthrax,  of  malignant  edema,  and  of  gas  gangrene;  the  others  are 
generally  incapable  of  enduring  long  the  unfavorable  conditions  of 
the  soil  and  the  antagonism  of  the  saprophytes.  Thus  Klein  found 
that  very  few  of  the  bacteria  of  cholera,  typhoid  fever,  diphtheria, 
plague  and  tuberculosis  are  found  in  the  bodies  of  animals,  dead 
from  these  diseases,  a  month  after  their  burial.  It  has  been  ob- 
served that  pathogenic  bacteria  are  very  quickly  destroyed  in  peaty 
soils,  doubtless  on  account  of  the  organic  acids  which  the  latter 
contain. 

With  plenty  of  air  the  aerobic  saprophytes  cause  the  prompt  de- 
composition of  organic  matter  with  little  or  no  offensive  odor ;  but 
in  compact,  wet  or  impermeable  soil,  anaerobic  bacteria,  the  organ- 
isms of  putrefaction,  come  into  play  and  ill-smelling  gases  are 
evolved.  This,  however,  is  mitigated  or  entirely  neutralized  by  the 
remarkable  absorbent  power  of  earth  for  gases  and  vapors,  the 
gaseous  atoms  penetrating  into  the  intra-molecular  spaces  of  the 
soil  elements  and  condensing  therein.  This  power  varies  accord- 
ing to  the  composition  of  soils ;  sand  has  but  a  feeble  attraction  for 
gases,  while  humus  or  any  soil  rich  in  organic  matter,  if  not  too 
wet,  is  very  absorbent.  This  affinity  is  particularly  marked  for 
odorous  gases ;  thus  it  has  been  observed  that  ordinary  illuminating 
gas,  in  passing  through  a  layer  of  earth,  may  lose  its  characteristic 
odor  but  not  its  poisonous  constituents  which  thus  become  the  more 
dangerous  that  their  presence  is  unrevealed  to  the  sense  of  smell. 


CHAPTER  XLIX. 
CAMPS. 

Camps  vary  greatly  in  their  composition,  size,  form,  location  and 
purpose,  and,  although  the  principles  underlying  their  sanitation  are 
always  the  same,  the  sanitary  measures  called  for  will  vary  corre- 
spondingly. There  are  the  summer  camps  of  peace  time  for  field 
instruction  and  maneuvers,  with  many  of  the  comforts  of  garrison 
life;  camps  of  mobilization,  at  the  beginning  of  war,  where  troops 
are  mustered  and  organized,  after  being  stripped  of  superfluities, 
and  the  camps  of  actual  warfare,  necessarily  reduced  to  the  in- 
dispensable. In  presence  of  the  enemy,  before  or  after  a  battle, 
while  marching  and  maneuvering  for  position,  the  troops  may  have 
to  camp  many  nights  on  ground  which  is  objectionable  from  the 
sanitary  point  of  view.  They  remain  in  deployed  formation  and 
will  generally  bivouac  on  or  near  the  positions  they  occupy.  In 
this  formation  they  are  drawn  out  into  a  thin  line  and  therefore 
not  exposed  to  the  dangers  attendant  upon  crowding.  Bivouacs, 
especially  if  shelter-tents  are  not  available  or  cannot  be  put  up,  and 
the  weather  is  inclement,  expose  the  troops  to  severe  and  mostly 
unavoidable  hardships.  In  the  absence  of  tents,  protection  from 
the 'wind  may  be  obtained  by  throwing  up  an  earth  wall,  three  feet 
high,  the  earth  being  taken  from  the  outside  to  secure  exterior 
drainage  and  an  undisturbed  surface  to  rest  upon  (WoodhuU}. 
When  a  choice  is  possible,  the  principles  which  guide  in  the  selec- 
tion of  camp  sites  will  apply  to  the  selection  of  places  for  bivouacs. 
According  to  Lord  Wolseley,  sanitary  reasons  should  always  be 
considered  in  the  choice  of  a  camp  when  contact  with  the  enemy 
is  not  expected  within  48  hours.  Every  shelter  should  be  utilized. 
Woodlands  are  always  desirable  on  account  of  the  shelter,  fuel  and 
material  they  afford.  When  troops  are  likely  to  remain  days  and 
weeks  along  the  line  of  fire,  confronting  the  enemy,  they  should 
make  themselves  as  comfortable  as  conditions  permit,  in  trenches 
and  dugouts,  or  in  tents,  and  carefully  observe  all  sanitary  measures 
applicable  to  their  situation. 

Selection  of  Site.  —  The  Field  Service  Regulations  provide  that 

603 


604  MILITARY    HYGIENE. 

"  when  practicable,  a  medical  officer  assists  in  the  selection  of  camp 
sites."  When  there  are  no  tactical  questions  involved  and  the  camp 
is  to  be  occupied  for  some  time,  sanitary  considerations  should  pre- 
vail and  great  responsibility  will  rest  upon  the  medical  officer  con- 
cerned in  the  recommendation  of  a  suitable  site. 

When  in  the  enemy's  territory,  careful  information  must  be  ob- 
tained from  the  inhabitants  regarding  the  prevailing  diseases  of  man 
and  animals  in  the  zone  to  be  occupied,  especially  in  the  proximity 
of  the  camp  grounds,  as  well  as  the  quality  of  the  water-supply  and 
the  character  of  the  food  to  be  procured  from  local  sources. 

The  grounds  should  be  large  enough  to  accommodate  the  com- 
mand without  crowding.  The  spread  of  infectious  diseases  in 
camp  is  always  to  be  apprehended,  being  favored  by  the  concen- 
tration of  large  numbers  of  men,  most  of  them  at  a  very  susceptible 
age,  under  hygienic  conditions  seldom  entirely  satisfactory.  To 
guard  against  it,  individual  men  must  be  given  as  much  space  as 
possible  within  their  respective  organizations,  and  the  organizations 
placed  as  far  apart  as  topographical  conditions  and  military  exi- 
gencies permit.  A  brigade  of  4.000  or  5,000  men  is  as  large  a  com- 
mand as  should  be  placed  in  one  camp.  The  site  should  be  high 
enough  to  secure  dry  soil  and  good  natural  drainage ;  the  summit 
of  a  low  ridge  with  gentle  slopes,  a  high  plateau  with  slight  declivity, 
or  the  high  bank  of  a  river,  are  very  desirable.  It  is  quite  im- 
portant that  the  location  of  a  camp  be  such  that  its  drainage  shall 
not  pollute  the  grounds  of  the  camp  next  below  it ;  if  such  location 
cannot  be  avoided,  a  large  ditch  should  be  dug  between  them.  In 
cold  weather,  a  slope  to  the  south,  with  woods  to  break  the  force 
of  the  wind  is  an  advantage.  In  hot  weather,  high  grounds,  swept 
by  the  breeze  and,  if  possible,  shaded  by  trees,  should  be  preferred. 
Grounds  near  the  foot  of  a  hill  are  exposed  to  flooding  in  rainy 
weather  and  remain  muddy  and  wet  long  afterwards ;  unless  pro- 
tected by  a  deep  ravine,  they  should  be  avoided. 

The  vicinity  of  marshes  and  stagnant  waters  is  objectionable  on 
account  of  the  annoyance  and  danger  of  mosquitoes;  it  is  also  un- 
desirable on  account  of  the  damp  atmosphere  and  possible  air  pol- 
lution from  CO2,  sulphureted  hydrogen,  marsh-gas,  ammonia  and 
other  products  of  organic  decomposition.  Although  marsh  water 
may  be  very  foul,  the  vapor  rising  from  it  by  evaporation  is  always 
entirely  free  from  micro-organisms  and  therefore  incapable  of  con- 
veying any  infectious  disease. 


CAMPS.  605 

An  old  camp  site  should  not  again  be  used  by  a  command  until 
sufficient  time  has  elapsed  for  the  disinfecting-  action  of  the  air,  sun 
and  rain;  this  period  of  time  will  vary  according  to  the  extent  of 
the  pollution,  especially  of  the  amount  of  fecal  matter  left  in  the 
soil  or  subsoil.  As  a  rule,  in  dry  weather,  a  period  of  two  or  three 
months  will  remove  all  danger  of  soil  infection. 

A  camp  site  must  be  dry.  A  humid  atmosphere  makes  the  heat 
more  oppressive  and  the  cold  more  penetrating.  Moisture  renders 
the  soil  cold  and  chilly,  depresses  the  body  vitality  and  reduces  re- 
sistance to  disease,  predisposing  to  rheumatism,  neuralgia,  diarrhea, 
tuberculosis  and  malarial  fever.  The  degree  of  dryness  of  a  site 
can  be  estimated  from  the  general  topography  of  the  surrounding 
country,  its  elevation  above  the  nearest  ponds  and  streams,  the  char- 
acter of  the  vegetation  and,  more  surely,  from  the  depth  of  the 
ground  water  as  determined  by  digging.  The  ground  water,  as  a 
rule,  should  not  be  nearer  than  10  or  12  feet,  but  a  depth  of  6  to  8 
feet  is  compatible  with  a  dry  surface  when  the  drainage  is  good 
and  the  subsoil  porous. 

Soil.  —  The  soil  and  subsoil  of  a  camp  must  be  porous  and 
permeable,  that  is,  allow  rain-water  to  sink  readily  through  them. 
Gravel  and  sand  are  excellent  for  the  purpose.  Loams  (mixtures 
of  sand,  clay  and  organic  matter),  although  not  so  good  are  gen- 
erally satisfactory.  The  most  iinhealthful  constituent  of  the  soil 
is  clay,  for  although  it  absorbs  and  holds  much  moisture  it  is  totally 
impermeable ;  whether  forming  the  soil  or  subsoil  it  retains  the  sur- 
face water  which  only  partially  disappears  by  slow  evaporation. 
Chalk,  limestone  and  sandstone  are  porous  and  healthful,  but  chalk 
mixed  with  clay  in  about  equal  proportion  (marl)  becomes  imper- 
meable. Volcanic  rocks,  such  as  granite,  trap,  gneiss,  etc.,  except 
when  seamed  and  fissured,  are  impervious ;  but  as  they  absorb  little 
water  and  dry  quickly  they  make  excellent  sites,  provided  there  is 
enough  slope  for  good  drainage. 

As  already  stated  under  Soil,  sand  allows  water  to  pass  through 
it  while  retaining  very  little  of  it.  If  white  or  light  colored,  it  does 
not  absorb  much  heat  during  the  day  and  loses  but  little  at  night ; 
in  other  words,  the  power  of  heat  absorption  and  radiation  of  white 
surfaces  is  small.  As  a  rule,  sand  does  not  contain  much  organic 
matter  and  therefore  does  not  favor  the  development  of  pathogenic 
microbes.  These  are  all  good  reasons  for  preferring  sand  as  camp 


606  MILITARY  HYGIENE! 

soil;  but,  if  nearly  pure,  it  is  likely  to  be  soft,  yielding  and  heavy 
to  the  foot  of  man  and  beast;  while,  if  white,  the  glare  of  its  sur- 
face is  trying  to  the  eye;  it  is  best  that  it  should  be  mixed  with  a 
certain  proportion  of  gravel  to  give  it  consistency  and  firmness  as 
well  as  a  neutral  color. 

Vegetation.  —  Vegetation  on  a  camp  site  is  highly  desirable,  but 
thick  undergrowth  which  excludes  the  sun  and  keeps  the  ground 
moist  must  be  cleared  out.  Trees  and  shrubs  should  be  saved  as 
far  as  possible  so  long  as  they  do  not  seriously  interfere  with  drills 
and  formations.  They  afford  protection  from  sun  and  wind  and 
modify  the  extremes  of  temperature,  cooling  the  summer  heat  and 
tempering  the  winter  cold.  Grass  is  most  useful  on  camp  grounds 
and  should  be  preserved  and  protected.  It  mitigates  the  heating 
of  the  soil  by  day  and  its  chilling  by  night;  does  not  reflect  light 
and  heat,  prevents  mud  and  dust,  as  well  as  the  washing  and  gutter- 
ing of  the  soil  by  rain. 

The  effect  of  vegetation  upon  mosquitoes  and  other  insects  is 
variable.  It  has  no  special  attraction  for  them  nor,  in  the  absence 
of  stagnant  water,  does  it  afford  them  breeding  places,  for  it  is  a 
well-known  fact  that  mosquito  eggs  are  only  laid  in  water  or  muddy 
places.  But  vegetation  affords  them  shelter  during  their  flights  in 
search  of  water,  or  when  blown  by  the  breeze,  and  may  thus  retain 
them  in  the  vicinity  of  habitations.  Therefore,  in  a  malarial  coun- 
try it  is  well,  in  camps  and  near  dwellings,  to  have  the  trees  thinned 
out,  no  undergrowth,  and  the  grass  closely  cut.  On  the  other  hand, 
a  screen  of  wood  between  mosquito-breeding  waters  and  the  camp 
grounds  will  stop  many  of  these  insects  and  be  distinctly  advan- 
tageous. 

The  location  of  a  camp  will  be  especially  determined  by  the  water- 
supply  which  should  be  abundant,  of  good  quality  and  conveniently 
accessible.  Grass  or  hay,  as  well  as  wood,  are  also  essential,  but 
can  be  brought  from  more  distant  points. 

POISONOUS  PLANTS.  —  There  are  but  few  poisonous  plants  in  this 
country  likely  to  trouble  soldiers  in  camp  or  on  the  march.  The 
worst  belong  to  the  genus  Rhus  or  Sumach.  Rhus  toxicodcndron 
(Poison  Ivy  or  Poison  Oak),  is  found  from  Canada  to  Mexico  and 
west  to  Arizona,  Oregon  and  P>ritish  Columbia,  under  various  forms 
ranging  from  a  small  upright  shrub  to  a  high  thrifty  climber;  easily 
recognized  by  its  trifoliate  leaves  and  ovate  pointed  leaflets,  one 


CAMPS.  607 

of  the  very  few  shrubs  or  woody  vines  with  three  leaflets.  In  Cali- 
fornia it  is  replaced  by  Rhus  diversiloba  which  differs  only  by  the 
obtuse  or  rounded  apex  of  the  leaflets.  Both  species  are  very 
poisonous  to  susceptible  people  and  should,  so  far  as  practicable, 
be  eradicated  from  camp  grounds.  Rhus  vernix  or  Poison  Sumach, 
of  the  wooded  swamps  of  the  Eastern  and  Middle  States,  a  large 
upright  shrub  or  small  tree,  having  long  pinnate  leaves  with  7  to  13 
entire  leaflets,  although  likewise  very  toxic,  is  not  common  enough 
to  be  much  of  a  menace  to  our  camps. 

In  the  West  Indies  the  closely  allied  genus  Comocladia  takes  the 
place  of  Rhus.  The  species  are  all  shrubs  or  small  trees  with  com- 
pound leaves  and  stiff  leaflets  armed  with  spiny  teeth.  The  best 
known  and  perhaps  most  poisonous  is  C.  dentata,  the  Guao  of  Cuba, 
and  Carrasco  of  Porto  Rico,  a  slender  upright  shrub  bearing  a  whorl 
of  shiny  leaves  near  the  top. 

The  poisoning  caused  by  these  species  of  Rhus  and  Comocladia, 
on  susceptible  persons,  is  in  the  form  of  a  more  or  less  severe  der- 
matitis. It  has  been  shown  that  the  toxic  principle  is  an  amber- 
colored,  non-volatile  liquid  resin,  so  that  actual  contact,,  direct  or 
indirect,  with  some  part  of  the  plant  is  necessary  to  produce  it. 
The  sticky  sap,  exhuding  from  all  parts  of  an  injured  plant,  comes 
readily  in  contact  with  hands  or  other  exposed  portions  of  the 
body,  or  may  be  carried  on  clothing,  furs  of  animals  or  various 
objects.  From  the  hands  it  is  usually  conveyed  to  the  face.  Poison- 
ing may  also  result  from  exposure  to  smoke  from  burning  stems. 
The  pollen  and  hairs  of  the  plant  do  not  contain  the  toxic  substance 
and  are  therefore  harmless.  Insects  may  carry  it  but  probably  in 
too  small  quantity  to  do  much  harm. 

Certain  peculiarities  distinguish  dermatitis  venenata  from  eczema 
and  herpes.  It  frequently  begins  between  the  fingers,  is  acute  in 
character,  with  swelling  and  often  large  vesicles  and  blebs ;  occurs 
in  sharply  defined  patches,  elongated  streaks  and  other  irregular 
shapes  corresponding  with  the  original  area  of  contact.  It  seldom 
attacks  the  scalp  or  the  inside  of  the  hands. 

Since  the  poison  is  soluble  in  alcohol  and  in  alkalies,  the  rational 
treatment  consists  in  removing  as  much  of  the  toxic  resin  as  pos- 
sible by  scrubbing  the  parts  with  soapsuds  and  washing  them  freely 
with  alcohol.  In  the  absence  of  alcohol,  gasoline  may  be  used. 
Afterwards,  a  2  per  cent,  solution  of  potassium  permanganate  (if 


608  MILITARY    HYGIENE. 

temporary  discoloration  of  skin  is  not  objectionable),  or  a  5  Per 
cent,  solution  of  bromin  in  glycerin,  is  recommended. 

Nearly  all  the  plants  of  the  Spurge  Family  (Euptiorbiacece)  con- 
tain a  milky  juice  more  or  less  acrid  and  irritating  to  the  skin.  Some 
produce  skin  eruptions  through  their  stinging  hairs.  One  of  the 
worst  members  of  the  family  is  the  Manchineel  or  Manzanillo 
(Hippomane  mancinella)  of  the  keys  of  Florida,  West  Indies  and 
Central  America,  a  medium  tree  with  smooth  bark  and  ovate,  finely 
serrate  leaves,  growing  on  seacoast  and  along  river  banks.  It  se- 
cretes an  abundant  white  juice  extremely  caustic.  A  few  drops 
internally  cause  drastic  discharges,  and,  in  the  eye,  may  produce 
blindness.  The  fruit  is  a  small,  attractive,  pleasant-smelling  apple, 
but  so  acrid  that  no  one  is  ever  tempted  to  take  a  second  bite. 

Another  notable  euphorb  of  the  West  Indies  is  the  Pinion 
Botija  of  Cuba,  and  Tartago  of  Porto  Rico  (Jatropha  curcas),  a 
small  tree  with  palmately-lobed  leaves,  pale  yellow  flowers  and 
greenish  plum-like  fruit  drying  black  and  containing  three  large 
bluish  seeds.  These  have  a  sweet,  pleasant  taste  and  exactly  the 
effect  of  castor  oil ;  they  are  an  excellent  cathartic  in  the  dose  of 
one  or  two. 

Many  of  the  fruits  and  seeds  of  the  plants  of  the  Nightshade 
Family  are  more  or  less  dangerous.  Careless  persons  are  some- 
times poisoned  by  eating  the  seeds  of  Datura  (Jimson  weed),  of 
which  we  have  several  kinds,  or  the  berries  of  various  species  of 
Solatium. 

The  Poison  Hemlock  of  Europe  (Conium  maculatum)  has  also 
become  common  in  this  country.  Cases  of  poisoning  arise  from 
mistaking  the  seeds  for  those  of  anise,  the  leaves  for  parsley  and 
the  roots  for  parsnip.  The  danger  from  Water  Hemlock  (Cicuta 
maculata  and  others)  is  from  the  roots,  often  washed  out  of  the 
soil,  exposed  to  view,  and  very  poisonous. 

Mushrooms.  —  Regarding  mushrooms,  a  good  rule  for  soldiers 
is  never  to  eat  them,  except  after  inspection  by  an  authorized  expert. 

The  common  edible  mushroom  (Agaricus  campcstris}  has  a  con- 
vex, expanded  cap,  smooth  or  oftener  silky-hairy,  usually  white  but 
varying  to  light  brown.  The  gills  are  first  white  but  very  soon 
become  pink  and  later  purple-brown  or  dark  brown  from  the  numer- 
ous colored  spores  on  their  surface ;  they  are  free  from  the  stem 
and  rounded  at  the  inner  ends.  The  veil  (or  membrane  covering 


CAMPS.  609 

the  gills  in  the  young  plant)  is  thin,  silky  and  very  frail;  as  the 
cap  expands  it  is  torn  irregularly  and  clings  as  a  thin,  ragged  collar 
around  the  stem,  while  fragments  remain  dangling  from  the  margin 
of  the  cap.  The  stem  is  white,  nearly  cylindrical  or  slightly  taper- 
ing at  the  lower  end.  This  mushroom  grows  mostly  in  open  places, 
such  as  lawns  and  pastures. 

Very  much  like  it,  is  another  highly  esteemed  edible  species 
(Lcpiota  nancina),  found  at  the  same  time  and  in  the  same  places. 
It  is  chiefly  distinguished  by  its  gills  which  remain  white,  only  be- 
coming pinkish  when  very  old.  The  cap  is  very  smooth  and  be- 
comes strongly  convex.  The  veil  separates  cleanly  from  the  stem 
as  well  as  from  the  margin  of  the  cap.  The  stem  is  slightly  en- 
larged or  bulbous  below. 

Many  other  edible  species  will  be  found  described  in  special 
treatises  on  the  subject. 

In  collecting  mushrooms  for  the  table,  W.  H.  Gibson's  advice  is 
excellent :  "  Avoid  every  mushroom  having  a  cup,  or  suggestion  of 
such,  at  its  base ;  the  distinctly  fatal  poisonous  kinds  are  thus  ex- 
cluded. Reject  those  having  an  unpleasant  odor,  a  peppery,  bitter 
or  other  unpalatable  flavor,  or  tough  consistency." 

The  two  most  common  of  the  deadly  mushrooms  are  the  Aman- 
itas,  both  characterized  by  having  the  stem  resting  in  a  cup-like 
bulbous  base. 

A.  phalloides  is  probably  responsible  for  a  majority  of  deaths  from 
eating  mushrooms.  It  is  white  in  all  its  parts,  with  smooth,  viscid 
cap.  Generally  occurs  in  woods,  but  rarely  also  in  open  fields. 

A.  mnscaria  is  distinguished  by  its  bright  orange  or  red  cap  cov- 
ered with  soft,  whitish  warts,  and  its  white  gills  and  stem. 

Of  the  poisonous  principles  of  mushrooms,  the  alkaloid  muscarine 
is  probably  the  most  potent.  They  do  not  act  until  several  hours 
after  the  ingestion  of  the  plant.  The  treatment  consists  in  produc- 
ing emesis  and  then  catharsis,  and  in  the  administration  of  atropine 
as  a  physiological  antidote. 

VENOMOUS  ANIMALS.  —  Since  soldiers,  in  camping  and  marching, 
are  particularly  exposed  to  the  bites  of  poisonous  animals,  a  brief 
description  of  them  may  be  useful. 

Snakes  are  the  best  known  and  most  dangerous.  Poisonous 
snakes  are  characterized  by  a  movable  poison  fang  on  each  side  of 
the  anterior  end  of  the  upper  jaw,  and  a  pit  between  the  eye  and 


6lO  MILITARY    HYGIENE. 

the  nostril.  The  coral  snake  differs  from  the  other  poisonous  kinds 
in  having  the  fangs  permanently  erect,  and  no  pit.  As  the  snake 
bites,  the  pressure  of  the  temporal  muscle  upon  the  poison  gland 
forces  its  contents,  along  a  fine  canal,  through  the  fang  into  the 
wound.  If  a  bite  consists  of  two  isolated  punctures  (sometimes 
only  one  visible),  it  is  almost  certain  to  be  from  a  poisonous  snake, 
and  the  distance  between  the  punctures  gives  an  indication  of  the 
size  of  the  animal  and  the  probable  amount  of  poison  injected. 

In  the  United  States,  the  poisonous  snakes  belong  to  four  distinct 
genera,  as  follows: 

Coral  snake  or  Harlequin  Snake  (Elaps  fnlvins},  with  small, 
cylindrical  body  marked  by  bright  red,  black  and  yellow  rings,  indis- 
tinct head  and  short  tail.  Inhabits  the  Southern  and  Southwestern 
States.  Feebly  poisonous.  Another  species  is  found  in  northern 
Mexican  deserts  and  probably  in  Arizona. 

Copperhead  (Agkistrodon  contortri.i'),  of  light  chestnut  color, 
with  Y-shaped,  darker  blotches  on  sides,  seldom  exceeding  3  feet  in 
length,  is  widely  distributed  from  Mass,  to  Fla.,  Ind.,  111.,  Tex.  and 
Ind.  Ty.  A  more  aggressive  animal  than  rattlesnakes,  but  its  poison 
much  less  virulent.  According  to  Prentiss  Wilson,  at  least  one-fifth 
of  all  cases  of  snake  bites  in  this  country  are  from  the  Copperhead. 
Out  of  99  cases,  5  fatalities  were  recorded,  but  only  one  was  prop- 
erly attributable  to  the  venom.  Therefore  severe  treatment  is 
seldom  called  for. 

Water  Mocassin  or  Cottonmouth  (Agkistrodon  piscivorus},  of 
dark  chestnut-brown  color  with  darker  markings,  and  white  mouth, 
ranges  from  N.  Ca.  to  Fla.,  Tex.,  Mexico,  the  Mississippi  River  and 
its  lower  tributaries.  Viciously  aggressive  but  its  poison  even  less 
virulent  than  that  of  the  Copperhead.  Being  much  heavier  than  the 
latter,  often  exceeding  4  feet  in  length,  it  is  capable  of  injecting  a 
larger  dose  of  poison.  Records  of  its  bite  are  rare. 

Rattlesnakes,  characterized  by  the  horny  rings  which  form  a  rattle 
at  the  tail  end.  They  have  been  divided  into  2  genera:  Sistrurus, 
with  top  of  head  covered  by  a  few  regular  shields,  and  Crotalus, 
with  top  of  head  covered  by  numerous  scales.  The  Sistrurus  or 
Ground  Rattlesnakes,  of  which  2  or  3  species  are  known,  are  but 
feebly  poisonous. 

Of  the  17  species  of  Crotalus,  not  less  than  10  are  found  in  the 
United  States,  most  of  them  extending  into  Mexico.  The  other 


CAMPS.  6 1  I 

species  are  found  in  Mexico,  Central  and  South  America.  None 
occur  in  the  West  Indies.  In  southern  Arizona  alone,  7  species  are 
found,  probably  all  extending  into  Mexico. 

Our  best  known  and  most  dangerous  species  are : 

Dog-faced  Rattlesnake  (C.  molossus),  of  a  general  sulphur  color, 
occurs  in  the  States  bordering  upon  the  Mexican  frontier. 

Banded  R.  (C.  horridus},  of  sulphur  color  with  series  of  subrhom- 
boidal  markings,  formerly  common  all  over  the  Eastern  States  and 
still  found  in  New  England,  but  oftener  in  the  Alleghany  Mountains. 

Diamond  R.  (C.  adamanteus},  of  general  yellowish-gray  color, 
with  rhomboidal  black  blotches,  ranges  from  N.  Ca.  to  Fla.  and 
west  to  the  Mississippi.  Often  found  in  water,  hence  its  common 
name  of  "  water  rattler."  Our  largest  species,  sometimes  8  feet 
long,  and  perhaps  the  most  dangerous. 

Texas  R.  (C.  atrox),  of  general  yellowish-gray  color,  with  series 
of  subhexagonal  rings  from  head  to  tail,  inhabits  the  arid  regions 
of  the  Southwest. 

Prairie  R.  (C.  conflnentns),  of  general  yellowish-brown  color,  with 
subquadrate  to  oval  dark  blotches,  ranges  between  the  Missouri 
River  and  the  Rocky  Mountains. 

Horned  R.  (C.  cerastes],  with  projection  over  the  upper  jaw,  is 
found  in  Ariz.,  Cal.  and  Sonora. 

Pacific  R.  (C.  Incifer},  the  common  rattler  of  the  Pacific  coast. 

Two  other  species  of  the  pit-viper  or  rattlesnake  family,  with  tail 
ending  into  a  long  horny  spine  instead  of  a  rattle,  deserve  mention: 
the  Bushmaster  (Lachesis  miitus)  of  tropical  South  America,  some- 
times 12  feet  long,  and  the  most  dangerous  snake  of  the  New  World ; 
the  Fer-de-Lance,  Lance-headed  or  Yellow  Viper  (Bothrops  lanceo- 
latus},  about  6  feet  long,  which  infests  the  sugar  plantations  of  the 
Martinique  and  other  West  India  Islands. 

Cuba  and  Porto  Rico  are  free  from  poisonous  snakes.  The  Phil- 
ippines contain  several  of  them  including  the  deadly  cobra  (Naja), 
but  are  nowhere  common  nor  aggressive,  and  records  of  deaths  from 
their  bites  are  rare.  The  best  known  is  the  Rice  Snake  (Dehen 
Palay}  greatly  feared  of  the  natives. 

The  danger  of  a  snake  bite  depends  not  only  upon  the  species  and 
the  virulence  of  its  venom,  but  also  upon  the  size  of  the  animal,  the 
more  or  less  successful  introduction  of  one  or  both  fangs,  the  part 
struck,  whether  a  vein  was  entered  or  not,  and  the  power  of  resist- 


6l2  MILITARY    HYGIENE. 

ance  of  the  person  struck.  The  poison  gland  may  also  be  emptied, 
or  partly  so,  from  a  previous  bite.  It  follows  that  the  effects  of 
bites  are  quite  variable,  sometimes  hardly  perceptible,  at  other  times 
fulminant. 

Dr.  Charles  B.  Penrose,  after  careful  investigations  and  experi- 
ments at  the  Philadelphia  Zoological  Garden,  recommends  the  fol- 
lowing treatment: 

"  Ligate  the  part  above  the  bite  with  rubber  ligature.  If  the 
bite  is  on  the  finger,  use  the  small  ligature  on  the  finger,  and  put 
the  large  ligature  on  the  forearm,  or  above  the  elbow. 

"  Make  one  or  two  deep  incisions  through  both  fang  punctures. 
The  incisions  should  be  ^2  inch  long  and  *4  to  j/^  inch  deep,  and 
should  bleed  freely. 

"  Suck  the  wounds.  It  is  best  to  spit  out  the  blood,  though  it  is 
not  dangerous  for  adults  to  swallow  snake  venom. 

"  Wash  the  wound  with  a  freshly  prepared  solution  of  chloride 
of  lime,  i  part  of  chloride  of  lime  to  60  parts  of  water.  Inject 
with  a  hypodermic  syringe  the  chloride  of  lime  solution  in  the 
tissues  around  the  wound — chiefly  above  the  wound." 

Hypodermic  injections  of  strychnine,  repeated  as  necessary,  may 
be  indicated,  as  well  as  whisky  in  ounce  doses  carefully  watched. 

In  localities  where  venomous  snakes  are  common,  medical  offi- 
cers will  do  wisely  to  procure  a  tube  of  the  anti-venom  prepared  by 
the  Pasteur  laboratories,  for  use  in  case  of  need. 

Next  to  snakes,  scorpions  deserve  mention.  These  animals  do 
not  poison  by  biting,  but  by  stinging  with  the  sharp-pointed  last  seg- 
ment of  the  body,  through  which  the  poison  is  injected  into  the 
puncture.  In  our  species,  as  found  in  the  Southern  and  Southwest- 
ern States,  the  sting  is  hardly  ever  more  serious  than  that  of  a  bee. 
In  Mexico,  dangerous  kinds  are  found,  especially  the  Alacran 
(Centrulus  gracilis),  yellowish  in  color  and  averaging  2  inches  in 
length.  Several  deaths  are  reported  from  its  sting  every  year  in 
the  State  of  Durango.  It  is  said  to  occur  occasionally  in  southern 
Arizona  and  California.  The  scorpions  found  in  Cuba  and  other 
West  India  Islands  are  more  troublesome  than  dangerous. 

Of  lizards,  two  species  of  the  genus  Heloderma  are  more  or  less 
poisonous;  one  is  the  sluggish  "  Hila  Monster"  of  Arizona  and 
northern  Mexico,  about  a  foot  long,  with  stout,  ungainly  body  and 
short,  thick  tail.  "  The  poisonous  glands  are  situated  at  the  point 


CAMPS.  613 

of  the  lower  jaw  and  the  venom  is  taken  up  by  the  wound  while  the 
animal  hangs  on  to  its  victim  with  the  tenacity  of  a  bulldog."  The 
second  species,  several  feet  long,  known  as  Crust  Lizard,  occurs  in 
Mexico. 

In  the  arid  regions  of  the  Southwest,  as  well  as  in  Mexico,  are 
several  kinds  of  poisonous  spiders,  injecting  venom  through  movable 
fangs  after  the  manner  of  snakes.  The  tarantula  is  especially  dan- 
gerous, its  bite  causing  acute  pain,  swelling  and  sloughing,  nervous 
disturbances  and  sometimes  death.  The  large  centipedes  of  hot 
and  dry  regions  are  capable  of  inflicting  painful  excoriations  by 
their  numerous  claws,  but  to  what  extent  they  are  venomous,  if  at 
all,  has  not  been  clearly  determined. 

May  also  be  mentioned,  the  Tropical  Toad  (Bufo  agu-a~)  of  South 
and  Central  America  and  southern  Mexico,  some  8  inches  long  and 
4  or  5  broad,  with  large  oval  glands  behind  each  ear,  which,  under 
irritation,  exhude  a  large  amount  of  a  creamy  secretion  having  a 
pungent  aromatic  odor,  and  a  deadly  arrow  poison.  It  is  said  to 
contain  epinephrin  and  a  substance  akin  to  digitalin  (Drs.  Abel  and 
Macht}. 


CHAPTER  L. 
CAMPS   (CONTINUED). 

TENTS. 

Troops  in  camps  are  usually  under  canvas.  Tents  give  shelter 
against  sun  and  rain  and.  to  some  extent,  against  cold,  but  do  not 
afford  the  protection  and  comfort  derived  from  ordinary  buildings ; 
for  hospitals  and  other  special  purposes  they  should  be  resorted  to 
only  when  suitable  buildings  are  not  available.  Flies,  or  outer  cov- 
ers, add  much  to  their  comfort  and  must  always  be  used  when  on 
hand,  being  adjusted  so  as  to  leave  an  air  space  between  them  and 
the  tent  roofs.  This  space  is  important,  but  need  not  be  so  great 
in  cold  as  in  hot  weather;  the  air  thus  enclosed  being  a  bad  heat 
conductor  excludes  the  sun's  heat  in  summer  and  prevents  loss  of 
interior  heat  in  winter. 

Tents  are  an  excellent  shelter  against  nocturnal  radiation  but,  even 
with  flies,  afford  an  imperfect  protection  against  heat  and  cold,  being 
easily  affected  by  weather  changes.  In  sunlight  they  absorb  and 
retain  heat  so  that  their  temperature  is  higher  than  that  of  the 
shaded  open  air.  Their  ventilation  is  generally  satisfactory  in 
summer  when  the  walls  can  be  lifted  and  the  doors  left  open;  it  is 
aided  by  the  free  exchange  of  gases  taking  place  through  the  canvas 
in  all  seasons.  But  in  winter,  when  it  is  necessary  at  times  to  pin 
down  the  walls  and  close  the  openings,  the  ventilation  is  often  im- 
perfect, although,  on  account  of  the  porous  walls,  seldom  very  bad. 
In  rainy  weather,  however,  when  the  pores  are  closed  by  the  con- 
tracting canvas,  the  air  may  become  quite  foul  and  diseases  of  the 
respiratory  tract  are  likely  to  spread.  Too  often  the  men  prefer 
warmth  to  fresh  air,  and,  in  winter,  will  generally  keep  the  hood 
of  the  pyramidal  tent  closed  tight.  For  this  reason,  it  was  found 
advantageous  in  some  of  the  Texas  camps  (1916)  to  replace  it  by  a 
fixed  metal  hood,  raised  4  inches  above  the  canvas  and  secured  in 
that  position,  thus  insuring  a  certain  amount  of  ventilation  at  all 
times. 

In  cold  weather,  tents  are  made  much  more  comfortable  by  lining 
the  wralls  with  blankets  or  thick  flannel :  even  paper  is  useful  for  the 

614 


CAMPS   (CONTINUED).  615 

purpose.  Except  on  very  cold  days  this  expedient  will  prove  a  good 
substitute  for  a  stove,  especially  when  fuel  is  scant. 

An  economical  way  of  heating  tents,  in  the  absence  of  stoves,  is  to 
make  a  fire  in  a  pit  in  front,  and  convey  the  heat  and  smoke  in  a 
zigzag,  underground  flue  through  the  tent,  to  an  outside  sod  chimney. 

In  permanent  camps,  the  comfort  of  the  soldier  is  much  increased 
and  his  health  promoted  by  the  use  of  board  flooring  in  tents,  each 
floor  consisting  of  two  or  more  sections  so  as  to  be  easily  carried, 
removed  and  replaced,  thus  permitting  of  ready  inspection  and 
cleaning  of  the  soil  area  beneath.  In  the  absence  of  wood  flooring, 
the  earth  floor  should  be  made  hard  and  as  impervious  as  possible  to 
subsoil  moisture.  About  3  inches  of  fine  gravel  well  rammed  down 
will  make  a  good  floor.  A  better  result  is  obtained  by  a  layer  of 
stone  (to  break  capillary  attraction)  covered  with  well-stamped 
earth,  and  top-dressed  with  mortar  3  or  4  inches  thick,  well  stamped 
down  as  it  begins  to  dry.  This  mortar  may  be  simply  made  of  finely 
screened  soil,  but  will  be  more  compact  and  solid  if  lime  is  added. 
A  floor  thus  constructed  will  be  raised,  as  it  should,  a  few  inches 
above  the  surrounding  level. 

The  tents  used  for  the  shelter  of  troops  in  our  service  are  of  vari- 
ous sizes  and  forms,  and  designated  as  shelter  tent,  wall  tents, 
storage  tent,  pyramidal  tent,  hospital  tent  and  hospital  ward  tent. 

Shelter  Tent.  —  The  field  equipment  of  all  European  armies,  ex- 
cepting the  French  and  English  armies,  comprises  a  shelter  tent.  In 
France,  the  issue  of  the  tente  d'abri  is  only  occasionally  authorized 
for  troops  operating  in  certain  inhospitable  regions.  In  Great 
Britain,  the  shelter  tent  is  still  looked  upon  as  an  unnecessary  luxury. 
It  was  not  used  during  the  Franco-Prussian  War  but,  since  then, 
has  been  adopted  by  both  Germans  and  Austrians. 

In  our  service,  each  man  on  the  march  carries,  as  part  of  his 
equipment,  one-half  of  a  shelter  tent,  weighing  3  pounds,  one  pole 
and  five  pins  of  cast  aluminum.  The  tent 'half  is  made  of  water- 
proof olive-drab  cotton  duck  and  serves  as  the  wrapper  of  his  pack. 
Two  halves  buttoned  together  at  the  ridge  form  the  complete  tent. 
It  is  pitched  on  two  3-jointed  poles  47  inches  long,  and  occupies  a 
space  64  inches  long  and  76  inches  wide.  An  additional  ground 
space  is  enclosed  when  the  two  triangular  flaps  are  pinned  down.  A 
double  tent  is  formed  by  buttoning  together  the  open  ends  of  two 
single  tents  (Fig.  185). 


6i6 


MILITARY    HYGIENE. 


FIG.  185. —  Double  shelter  tent. 

In  the  absence  of  poles  the  tent  can  be  supported  by  two  rifles, 
or  by  a  rifle  in  front,  and  by  a  bayonet  in  its  scabbard,  or  the 
intrenching  tool,  in  rear  (Fig.  186). 

Common  Tent.  —  The  common  tent  (or  A-tent)  of  former  days 
has  been  discarded  in  our  service. 

Wall  Tent.  —  Wall  tents  are  generally  intended  for  the  accommo- 
dation of  officers.  Two  types  are  provided,  the  large  and  the 
small,  both  with  flies. 

The  wall  tent,  large,  is  the  new  name  given  the  former  "  regula- 
tion hospital  tent."  It  is  n  feet  high,  14  feet  3  inches  long  and  14 
feet  6  inches  wide,  with  wall  4  feet  6  inches  high.  It  requires  one 
ridge,  two  upright  and  four  eaves  poles,  18  large  double-notched 


FIG.  186. —  Shelter  tent,  pitched  on  rifle  and  bayonet. 


CAMPS   (CONTINUED). 


617 


pins  and  26  smaller  pins.  In  each  end  there  is  a  door,  and  above 
and  to  the  right  is  a  "  ventilator  and  stovepipe  "  opening,  6  by  8 
inches,  to  serve  as  a  ventilator  in  summer  and  stovepipe  hole  in 
winter,  with  inside  flap  to  close  it  when  necessary  (Fig.  187). 


FIG.   187. —  Wall  tent,  large.     (Former  hospital  tent.) 

The  wall  tent,  small  (or  tropical  wall  tent),  is  8  feet  6  inches 
high,  9  feet  2  inches  long,  8  feet  n  inches  wide,  with  wall  3  feet 
9  inches  high  (Fig.  188).  The  sides  of  the  roof,  13^  inches  from 
the  apex,  are  drawn  in,  the  whole  length  of  the  tent,  by  a  horizontal 
band  of  canvas,  one  foot  wide,  which  forms  the  floor  of  an  attic  or 
"  pocket."  This  floor  is  perforated  by  6  holes,  each  6  inches  in 
diameter,  for  ventilation,  and  by  2  smaller  holes  (one  at  each  end) 
for  the  upright  poles  to  go  through.  Each  end  of  the  pocket  can 
be  closed  by  a  flap  in  inclement  weather.  Besides  the  ventilation 
produced  by  the  holes  in  the  floor  of  the  attic,  the  drawing  in  of  the 
sides  of  the  roof  separates  it  from  the  fly  and  increases  the  layer  of 
air  between  them,  so  that  this  tent  is  well  adapted  to  warm  climates. 

Conical  Tent.  —  The  conical  tent  has  been  discarded  and  is  no 
longer  used  in  our  service.  It  is  a  round  tent  with  conical  roof, 
supported  by  one  upright  pole.  This  pole  may  be  replaced  by  a 
stout  stovepipe  resting  upon  a  tripod  and  connected  with  a  Sibley 
stove  placed  within  the  tripod.  It  is  a  very  useful  tent  in  cold 
climates  where  stoves  are  necessary,  and  the  absence  of  flat  sur- 
faces enables  it  to  withstand  storms  better  than  other  types.  On 
the  other  hand,  it  is  not  adapted  to  warm  climates  on  account  of  its 
easily  heated  interior,  resulting  from  the  low  walls  and  absence  of 


6i8 


MILITARY    HYGIENE. 


FIG.  188. —  Wall  tent,  small,  with  fly.     (Tropical  wall  tent.) 

fly,  its  temperature  being  from  4  to  8  degrees  higher  than  that  of  a 
hospital  tent  under  similar  circumstances  (Fig.  189). 


'. :  •  '  '^ •">"/' 
FIG.   189. —  Conical  wall  tent,  showing  exterior. 


CAMPS   (CONTINUED). 


619 


FIG.  190. —  Pyramidal  tent,  open. 


FIG.  "191. — 'Pyramidal  tent,  closed. 


62q  MJLITARY_r  HYGIENE..) 

Pyramidal  Tent.  —  This  type  has  superseded  the  conical  tent.  It 
is  16  feet  square,  with  walls  3  feet  high,  and  n  feet  high  to  top  of 
roof,  weighing,  complete,  164  pounds  (Figs.  190  and  191).  Like 
the  conical  tent,  it  is  supported  by  a  central  pole  resting  upon  a 
strong  folding  tripod.  It  is  held  above  by  four  chains  hanging 
from  a  plate  passed  over  the  spindle  of  the  pole.  The  top  open- 
ing, 18  inches  square,  is  closed  with  a  movable  hood.  The  method 
of  heating  by  stove  and  pipe,  used  in  the  conical  tent,  is  also 
applicable  to  this  tent. 

Hospital  Tent.  —  Only  one  type  is  provided,  the  hospital  tent, 
tropical,  designed  for  warm  weather.  (Figs.  192,  193,  194.) 

The  tropical  hospital  tent  (model  1907)  is  12  feet  high,  10  feet 
6  inches  to  base  of  pocket,  14  feet  3  inches  long,  15  feet  7  inches 
wide,  with  wall  4  feet  7  inches  high  and  doors  10  feet  3  inches 
high.  The  sides  of  the  roof,  20^  inches  from  the  apex,  are  drawn 
in,  the  whole  length  of  the  tent,  by  a  horizontal  band  of  canvas,  22 
inches  wide,  which  forms  the  floor  of  an  attic  or  "  pocket."  This 
floor  is  perforated  b"y  4  holes  one  foot  in  diameter,  for  ventilation, 
and  by '2  smaller  holes  (one  near  each  end)  .for  the  upright  poles 
to  go  through.  The  pocket  has  4  holes  oh  each  side,  6  inches  in 
diameter,  the  center  of  holes  being  6  inches  from  the  floor.  These 
side  holes  can  be  covered  by  a  small  fly  6  feet  long  by  14  inches 
wide,  with  lines  to  brail  it  up  and  haul  down.  This  small  fly  is 
especially  intended  for  use  in  the  absence  of  the  regular  large  fly. 
The  pocket  can  be  closed  at  each  end  by  a  triangular  flap  18  inches 
wide  at  base  and  14  inches  long.  This  tent  requires  one  ridge,  two 
upright  and  four  eaves  poles,  36  large  double-notched  pins  and  26 
smaller  pins.  The  ridge  pole  is  18  feet  long,  spliced  in  center  with 
a  12-inch  thimble  joint  protected  by  a  sleeve  30  inches  long,  and  with 
hole  for  the  spindle  of  upright  pole  2  feet  from  each  end. 

The  ridge  pole  projects  2  feet  beyond  the  upright  at  each  end. 
The  fly  is  sufficiently  long  to  cover  this  extension  and  be  secured  to 
a  stud  at  the  end  of  the  contiguous  ridge  pole,  so  that  a  completely 
covered  space,  4  feet  long,  is  provided  between  the  tents. 

Besides  the  ventilation  produced  by  the  holes  in  the  floor  and  sides 
of  the  attic,  the  drawing  in  of  the  roof  separates  it  from  the  fly  and 
increases  the  insulating  layer  of  air  between  them. 


CAMPS"  (CONTINUED). 


621 


FIG.  192.—  Hospital  tent,  tropical,  with  fly: 


FIG.  193.— Hospital  tent,  tropical,  showing  interior. 


622 


MILITARY    HYGIENE. 


FIG.  194. —  Hospital  tent,  tropical,  showing  ventilation  of  attic. 

Hospital  Ward  Tent.  —  This  tent,  as  its  name  indicates,  is  speci- 
ally constructed  for  the  admission  and  treatment  of  patients,  and 
only  used  for  that  purpose,  having  materially  reduced  both  the  cost 
and  weight  of  the  tentage  required  by  field  hospitals.  (Fig.  195.) 


FIG.    195. —  Hospital    Ward    Tent. 


CAMPS    (CONTINUED).  623 

It  consists  of  tent,  4  uprights,  4  corner  poles,  72  large  and  56 
small  pins.  Its  dimensions  are :  length,  50  feet ;  width,  16  feet ; 
height,  10  feet;  height  of  wall,  4  feet  6  inches.  Its  total  weight  is 
555  pounds  and  packs  in  20  cubic  feet.  Through  the  four  vents  on 
ridge  the  tent  is  supported  on  the  poles  by  plates  and  chains,  the 
vents  being  covered  by  hoods.  It  accommodates  24  patients. 

Storage  Tent.  —  Its  dimensions  are:  length,  20  feet  5  inches; 
width,  17  feet  10  inches;  height,  13  feet;  height  of  wall,  5  feet  2 
inches.  Requires  i  ridge  and  3  upright  poles. 

Of  tents  used  in  foreign  armies  none  appear  especially  suitable  to 
our  service  or  to  possess  advantages  over  those  above  described,  with 
the  exception  of  the  wagon  or  tortoise  tent  officially  adopted  by  the 
English  and  French  and  well  worthy  of  special  mention.  It  is  rec- 
tangular in  shape,  23  feet  long  by  21  feet  wide  and  weighs,  complete, 
about  200  pounds.  It  is  carried  on  top  of  an  ordinary  army  wagon, 
forming  its  roof,  the  sides  being  rolled  up  and  supported  on  brackets. 
For  use,  it  is  unrolled  all  around  the  wagon,  which  takes  the  place 
of  a  ridge  pole,  and  held  up  by  16  light  poles  and  a  sufficient  number 
of  pins.  It  is  lighted  by  windows  made  of  an  oiled,  translucid  fabric. 
All  necessary  furniture  and  supplies  are  carried  in  the  wagon.  This 
tent  can  accommodate  16  cots  or  about  30  patients  lying  on  the 
ground.  Thi  facility  with  which  it  is  pitched,  furnished  and  sup- 
plied, independently  of  the  baggage  train,  gives  it  great  value.  In 
the  colonies  or  wherever  vehicles  cannot  go,  the  wagon  is  replaced 
by  a  ridge  pole  and  the  whole  outfit  carried  by  pack  animals. 

Two  other  tents  are  also  officially  recognized  in  the  French  Army, 
the  Toilet  and  the  Herbet  tents,  with  heavy  metallic  framework  and 
rather  complicated  structure,  therefore  not  adapted  to  our  service, 
although  (the  Herbet  tent  especially)  offering  great  sanitary  advan- 
tages and  comforts. 


CHAPTER  LI. 
CAMPS  (CONTINUED). 

IMPROVISED  AND  PORTABLE  BARRACKS. 

Where  timber  is  abundant  and  the  camp  is  to  be  of  some  duration, 
log  huts   with   well-plastered   joints,   canvas   roof   and   fly,   afford 


FIG.  196. —  Log  hut  with  canvas  roof.     (Smart.) 

excellent  shelter  and  are  preferable  to  tents.  Smart's  hut  (Fig.  196) 
is  13  by  7  feet,  and  6  feet  to  the  eaves,  and  accommodates  4  men 
on  two  double  bunks,  one  on  each  side  of  the  doorway.  Light  and 
ventilation  are  obtained  through  the  roof,  door  and  chimney.  More 
light  can  be  obtained  by  setting  a  sash  or  translucid  fabric  in  the 
upper  part  of  the  door. 

A  better  arrangement  is  that  suggested  by  Woodhull  (Fig.  197), 
in  which  two  huts,  8  by  1 1  feet,  stand  end  to  end,  6  feet  apart,  with 
doors  opening  upon  a  connecting  porch.  In  a  mild  climate  one 
chimney  between  the  huts  would  be  sufficient. 

For  winter  camps,  an  excellent  arrangement  is  that  devised  by 
Falk,  in  which  3  wall  tents  or  common  tents  are  placed  against  three 
sides  of  a  small,  square,  frame  cabin,  each  tent  connecting  with  it  by 

624 


CAMPS   (CONTINUED). 


625 


a  door.  (Fig.  198.)  A  stove  or  fire  in  the  cabin  warms  the  tents; 
around  it  the  men  gather  to  smoke  and  lounge.  Instead  of  glass 
panes  the  door  should  admit  light  through  a  translucid  tissue. 


11  ft.  11  ft. 

FIG.  197. —  Ground  plan  of  huts,  for  four  men  each,  with  covered  porch. 

When  campaigning  in  very  cold  countries  it  may  be  advisable  to 
construct  dugouts,  that  is  to  say,  huts  partly  excavated  in  the 
ground  and  covered  with  mud  roofs,  as  was  done  on  a  very  exten- 


FIG.   198. —  Falk's  arrangement  of  tents  in  winter  quarters. 

sive  scale  by  the  Russian  and  Japanese  soldiers  in  Manchuria. 
Such  dugouts  have  the  advantages  of  being  quickly  and  cheaply 
constructed,  easily  heated  and  not  conspicuous.  On  the  other  hand, 
they  are  difficult  to  police  and  ventilate,  and  likely  to  be  insanitary. 
It  should  be  noted,  however,  that  the  health  of  the  Russians  and 
Japanese  in  Manchuria  did  not  appear  to  be  in  any  way  impaired  by 
their  prolonged  stay  in  such  underground  structures  during  the 
winter  of  1904-5.  The  main  reception  hospital  of  the  Russians,  at 


626 


MILITARY    HYGIENE. 


Mukden,  near  the  railroad  station,  was  of  this  type.  (Fig.  199.)* 
In  sandy  soil,  the  sides  of  the  excavation  should  be  retained  by 
boards  and  stakes  as  in  the  German  type.  (Fig.  200.) 


FIG.   199. —  Underground  Russian  hospital  at  Mukden,  Manchuria. 


i 2,50 »j 

FIG.  200. —  Dugout  used  by  the  German  Army.     (Munson.) 

For  cantonments,  light  frame  barracks  of  various  models  have 
been  devised.  In  the  United  States  they  are  generally  heated  by 
stoves,  their  ventilation  being  chiefly  by  natural  perflation,  but  also, 
in  winter,  by  ducts  which  bring  fresh  air  under  the  floor  to  the 


*  Concerning  the  effect  of  trench  and  underground  life  on  the  health  of 
belligerent  troops  in  France   (1917),  see  page  747. 


CAMPS   (CONTINUED). 


627 


stoves,  the  foul  air  escaping  through  shafts  enclosing  the  stovepipes. 
An  excellent  workable  type  of  portable  buildings,  on  the  knock- 
down system,  for  our  cantonments  and  permanent  camps,  has  been 
devised  by  the  Quartermaster  Corps.  They  are  especially  intended 
to  shelter  latrines,  lavatories,  incinerators,  kitchens  and  messes,  and 
will  be  found  described  under  their  proper  headings. 


FIG.  201. —  Portable  hospital  pavilion,  system  Ducker. 

Portable  barracks  are  more  or  less  used  in  all  countries  for  the 
shelter  of  troops  as  well  as  for  hospital  purposes.  Two  of  the  best- 
known  types  are  the  Ducker  system  manufactured  by  the  Ducker  Co., 
of  New  York,  and  the  Doecker  system  manufactured  by  Christoph  & 
Unmack,  of  Niesky,  Germany.  The  Ducker  buildings  consist  of 
sections  2  feet  9  inches  wide,  easily  set  up  and  secured,  without  nail 
or  screw,  and  have  all  the  advantages  of  permanent  structures,  while 
capable  of  being  speedily  knocked  down  and  reconstructed.  By  the 
addition  or  removal  of  sections  they  can  be  increased  or  reduced  to 
any  desired  extent.  (Fig.  201.)  Another  model  is  shown  in  Fig. 
202,  a  tuberculosis-hospital  pavilion  at  Bellevue  Hospital,  New  York, 
These  portable  buildings  seem  to  be  particularly  well  adapted  to  the 
needs  of  permanent  summer  camps  at  home  and  in  our  colonies. 


628 


MILITARY    HYGIENE. 


FIG.  202. —  Portable  hospital  pavilion  with  double  roof  and  double  floor, 

system  Ducker. 

The  Doecker  portable  hospital  was  often  seen  in  Manchuria  during 
the  Russo-Japanese  War,  being  much  used  by  Red  Cross  societies 
with  great  satisfaction.     (Fig.  203.) 


FIG.  203. —  Portable  hospital,  system  Doecker. 


CAMPS   (CONTINUED). 


629 


FOBM   OF  THE   CAMP. 

When  not  in  presence  of  the  enemy,  battalions  and  squadrons  nor- 
mally camp  in  column  of  companies  or  troops  at  convenient  dis- 
tances. 

With  shelter  tents  the  arrangement  for  each  company  is  usually 
in  two  lines,  facing  each  other,  with  a  distance  of  15  yards  between 
the  lines ;  this  space  forms  the  company  street.  A  company  of  in- 


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Distances  in  yards.         Dimensions  of  Camp  300  «260  yards, 
for  65  men  to  the  company   Each  additional  tent  per  company  increases  th» 
trtdth  of  the  Camp  8  yard\ 


FIG.  204. —  Camp  of  a  regiment  of  infantry. 


630 


MILITARY    HYGIENE. 


fantry  thus  occupies  a  space  of  20  yards  in  depth.  If  pitched  in  a 
single  line,  the  tents  face  the  head  of  the  column. 

With  pyramidal  tents  each  company  forms  a  single  row,  the  dis- 
tance between  the  tents,  from  center  to  center,  being  8  yards. 

Between  adjacent  company  rows,  picket  lines,  and  gun  or  car- 
riage parks,  center  to  center  the  distance  is  20  yards. 

Latrine  seats  are  provided  at  the  rate  of  one  seat  to  every  10  men, 
and  shower  heads  at  i  to  every  50  to  100  men. 

In  a  camp  of  cavalry  the  picket  lines  are  15  yards  in  rear  of 'the 
latrines. 

In  pitching  tents,  the  wall  or  bottom  pins  are  so  driven  as  to  slope 
slightly  away  from  the  tent ;  guy  pins,  so  as  to  slope  slightly  toward 
the  tent.  For  this  purpose  a  maul  is  better  than  an  axe,  the  handle 
not  being  so  liable  to  break  nor  the  pins  to  split.  It  is  well  to  re- 
member that  the  tent  cords  contract  when  wet  and  expand  when 
dry.  Therefore  they  should  be  loosened  when  it  rains  so  that  their 


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FIG.  205.  —  Plan  of  the  three  field  hospitals  of  a  division. 
of  9.2  acres   (160x280  yards). 


Covering  an  area 


CAMPS   (CONTINUED).  631 

contraction  may  not  pull  out  the  pins,  and  tightened  again  as  they 
dry.  In  case  of  very  heavy  dew  this  may  have  to  be  done  night  and 
morning. 

From  the  sanitary  point  of  view,  the  great  guiding  principle,  in 
forming  camp,  is  to  separate  the  kitchens  and  messes  as  far  as  pos- 
sible from  the  latrines.  Therefore,  the  rule  is  to  place  the  kitchen 
on  one  flank  of  the  company  and  the  latrine  on  the  other.  The  dis- 
tance from  latrines  to  the  nearest  occupied  tent  is  at  least  50  yards, 
but  when  a  smaller  camp  is  desired  this  space  may  be  used  to  park 
carriages  and  animals. 

When  shelters  or  other  conveniences  for  company  messes  are  pro- 
vided, they  are  placed  in  line  with  the  company  tents,  between  the 
first  sergeant's  tent  and  the  cook's  fire,  this  interval  being  increased 
for  the  purpose.  Near  the  cook's  fire  is  the  store  tent,  and  a  pit  for 
liquid  wastes  when  no  better  provision  is  made  for  them.  Next  to 
the  line  of  kitchens  is  the  line  of  officer's  tents,  an  unobjectionable 
arrangement  which  facilitates  the  inspection  of  the  former,  thus 
ensuring  greater  cleanliness  and  more  efficient  management. 

When  a  regiment  is  camping  separately,  or  operating  independ- 
ently, it  should  be  accompanied  by  a  complete  regimental  hospital,  or 
as  complete  as  transportation  permits.  When  it  is  brigaded,  no  regi- 
mental hospital  is  necessary ;  only  an  "  infirmary  "  is  put  up,  con- 
sisting of  two  or  three  wall  tents,  all  hospital  patients  being  sent  to 
the  field  hospital.  This  infirmary  is  placed  in  the  best  available  site, 
as  free  from  dust,  noise  and  flies  as  possible.  As  it  keeps  only 
trivial  cases,  there  is  no  objection  to  its  location  near  the  men's  or 
officers'  rows. 


FIG.  206.— Perspective  of  field  hospital.    Fort  Riley  maneuvers,  1902. 


632 


MILITARY    HYGIENE. 


One  field  hospital  is  usually  assigned  to  each  brigade.  It  should 
be  in  an  easily  accessible  site,  near  a  good  water-supply  and  without 
too  much  regard  to  its  distance  from  the  regiments  for  which  it  is 
intended.  It  generally  consists  of  six  hospital  ward  tents,  and  such 


FIG.  207. —  Livonian  field  hospital,  Mukden,  Manchuria.  I,  portable  Doecker 
pavilion;  2,  large  Russian  hospital  tents;  3,  tortoise  tent  or  ridge  pole  (system 
Lefebvre)  ;  4,  Mongolian  felt  tent ;  5,  small  frame  barrack  for  personnel. 

other  tents  as  are  required  for  administration,  service  and  quarters. 
(Fig.  205.)  Of  the  3  hospital  tents  in  front  of  the  ward  tents,  the 
middle  one  is  used  as  office  and  dispensary,  another  as  operating 
room  and  the  third  for  stores.  A  perspective  view  of  a  field  hos- 
pital with  former  types  of  tents  is  given  in  Fig.  206.  In  the  course 
of  a  campaign,  in  the  absence  of  suitable  buildings,  it  may  be  neces- 
sary to  utilize  all  available  shelters ;  this  is  well  illustrated  in  Fig. 
207,  representing  a  field  hospital  at  Mukden,  Manchuria,  during 
the  Russo-Japanese  War. 


ESTABLISHMENT  OF  CAMP. 

Upon  arriving  at  the  selected  site,  the  first  duty  which  concerns  the 
medical  officer,  if  the  matter  has  not  previously  been  attended  to,  is 
an  examination  of  the  water-supply  and  the  determination  of  the 
place  or  places  where  drinking  and  cooking  water  should  be  drawn. 
Below  this,  if  the  supply  is  from  a  stream,  other  places  should  be 
likewise  set  apart  for  watering  animals,  for  bathing  and  washing 
clothing,  in  the  order  named. 


CAMPS   (CONTINUED).  633 

If  the  stream  be  small  it  will  be  of  advantage  to  construct  reser- 
voirs by  building  dams. 

Small  springs  may  be  dug  out  and  lined  with  stones,  brick,  or 
empty  barrels.  Surface  drainage  is  kept  out  by  a  curb  of  clay. 
Animals  will  in  such  cases  generally  have  to  be  watered  from 
troughs  or  buckets. 

If  the  water  be  of  doubtful  quality,  measures  must  be  at  once  taken 
to  filter  or  sterilize  it. 

In  a  permanent  camp  or  cantonment,  each  company  should  be 
provided,  for  drinking  water,  with  two  barrels  or  large  cans  with 
lids,  and  fitted  with  fawcets  near  the  bottom,  so  that  the  use  of  dip- 
pers may  be  dispensed  with.  These  barrels  should  be  on  a  con- 
venient platform,  and  a  soakage  pit  filled  with  stones,  dug  under 
the  drip. 

The  next  thing  requiring  the  attention  of  the  medical  officer  is  the 
digging  of  straddle  trenches  and  sinks.  This  should  be  begun  as 
soon  as  the  company  lines  are  laid  out,  suitable  places  designated 
and  tools  available.  Trenches  are  always  necessary.  They  are  the 
only  form  of  latrines  used  if  the  camp  is  not  to  last  more  than  2  or 
3  days  (see  page  637).  When  sinks  are  required,  as  it  will  take 
several  hours  for  their  preparation,  it  is  expedient  that  a  suitable 
spot,  for  each  regiment  or  battalion,  be  selected  and  a  dozen  trenches 
dug,  3  or  4  feet  long,  of  about  the  width  and  depth  of  the  spade. 
These  trenches  must  be  ready  by  the  time  the  camp  is  pitched,  or 
even  sooner  if  practicable ;  otherwise,  men  will  stray  beyond  their 
lines  and  almost  inevitably  ease  themselves  wherever  they  have  a 
chance  to  do  so  unseen  by  their  officers,  thus  violating  the  first  and 
most  important  law  of  camp  sanitation.  Trenches,  like  sinks,  must 
be  carefully  filled  up  before  leaving  camp,  and  all  fecal  matter  prop- 
erly covered. 

"  Tents,  company  streets  and  picket  lines  will  be  ditched  if  there 
be  time  available.''  The  earth  from  the  ditch  is  usually  thrown 
away  from  the  tent ;  it  should  never  be  thrown  upon  the  sod  cloth 
and  against  the  bottom  of  the  tent  wall,  unless  absolutely  necessary 
to  prevent  extreme  cold  or  a  dangerous  irruption  of  rain-water;  in 
such  position  the  earth  interferes  with  ventilation,  prevents  the  lift- 
ing of  the  walls  and,  by  favoring  dampness,  impairs  the  strength  of 
the  canvas. 

This  digging  of  a  small  gutter,  4  to  6  inches  deep,  around  tents  is 


634 


MILITARY    HYGIENE. 


Top  View 


Bottom  View 


Folded 
FIG.  208. —  Regulation  folding  cot. 

simply  for  the  purpose  of  keeping  their  floors  dry ;  the  inner  edge 
of  the  gutter  should  come  just  inside  the  skirt  wall  of  the  tent  to 
catch  the  water  running  down  the  wall  and  thus  protect  the  interior. 
When  the  camp  is  only  for  a  day  or  two  and  there  is  a  reasonable 
certainty  that  no  rain  will  fall,  such  digging  is  unnecessary;  but 
under  ordinary  circumstances  it  should  not  be  neglected.  These 
gutters  should  lead  into  the  trenches  of  the  company  street  and 
these  into  larger  ditches  so  that  the  whole  camp  may  be  properly 
drained. 


CAMPS  (CONTINUED).  635 

The  installation  of  a  camp,  so  far  as  the  comforts  of  the  men  are 
concerned,  will  depend  chiefly  upon  the  length  of  time  it  is  to  be 
occupied ;  thus  if  it  is  to  last  a  week  or  more,  the  grounds  should  be 
cleared  of  all  underbrush,  paths  and  roads  ditched,  bedded  and  grav- 
elled ;  rough  chairs,  benches  and  tables  may  be  constructed,  as  well 
as  shades  over  mess  tables,  latrines,  bathing  and  washing  places,  etc. 
These  simple  improvements  are  easily  made  and  add  greatly  to  the 
contentment  of  the  men ;  but  so  far  as  the  sanitation  of  the  camp 
and  the  health  of  the  men  are  concerned,  it  matters  little  what  the 
stay  is  to  be,  whether  short  or  long,  the  sanitary  measures  are  prac- 
tically the  same  and  to  be  applied  with  equal  strictness,  especially  in 
everything  that  concerns  the  correct  disposal  of  excreta  and  wastes. 

Soldiers,  so  far  as  possible,  should  not  sleep  on  or  too  near  the 
ground :  i,  because  the  soil  is  generally  damp  relatively  to  the  body, 
even  when  apparently  dry,  moisture  rising  up  very  readily  from  the 
wet  subsoil  by  capillarity;  2,  because  the  soil  and  vegetation  being 
liable  to  be  infected  by  disease  germs,  or  to  harbor  poisonous  insects, 
blankets  and  clothing  should  be  lifted  above  them;  3,  because  the 
atmosphere  near  the  soil  is  always  more  or  less  contaminated  by 
ground  air  which,  as  stated  before,  contains  a  large  proportion  of 
carbon  dioxid  and  other  obnoxious  gases  resulting  from  the  decom- 
position of  organic  matter,  especially  in  hot  climates. 

In  cantonments,  or  permanent  camps,  the  tents  may  be  pitched  in 
frames  and  floored,  and  bunks  constructed  or  cots  used.  In  winter, 
stoves  may  be  supplied  and  placed  upon  brick  or  stone  foundations. 
The  regulation  "  folding  cot  "  which  has  been  used  in  our  Army  for 
a  number  of  years  has  been  found  entirely  satisfactory.  (Fig.  208.) 
In  temporary  camps,  the  O.  M.  Corps  supplies  bedsacks  which  the 
men  stuff  with  straw,  grass,  leaves  or  brush.  In  the  absence  of  cot 
and  bedsack,  the  soldier  can  generally  make  himself  a  couch  of  the 
same  material  or  improvise  a  bedstead  with  a  few  stakes  and  cross 
sticks.  If  none  of  these  things  be  available  he  should  spread  his 
poncho  or  slicker  upon  the  ground,  under  his  blanket. 


CHAPTER  LII. 
LATRINES. 

Fecal  matter  is  not  only  repugnant  to  sight  and  smell  but,  in 
camp,  constitutes  the  chief  source  of  danger  to  the  health  of  the 
soldier.  It  may  contain  various  infectious  germs  and  from  it  are 
spread  the  camp  diseases  most  to  be  apprehended,  namely  cholera, 
typhoid  fever,  dysentery  and  diarrhea.  As  it  is  always  difficult  and 
often  impossible  to  detect  cases  of  these  diseases  in  their  early  pro- 
dromal stage,  or  before  patients  have  a  chance  of  polluting  the 
latrines,  the  first  sanitary  axiom  to  promulgate  in  a  camp  is  that  all 
excreta  (fecal  matter  and  urine)  are  to  be  considered  as  infected 
and  treated  accordingly.  A  firm  mental  grasp  of  this  axiom  helps 
to  a  clearer  understanding  of  the  peril  to  which  the  men  are  exposed 
and  suggests  the  measures  best  calculated  to  guard  against  it. 

Fecal  matter  and  urine  convey  the  germs  of  disease  through  food 
and  drink,  that  is  to  say,  by  being  directly  ingested  into  the  stomach. 
There  is  also  a  probability  that  these  germs,  as  they  float  in  the  air 
dust,  are  absorbed  by  inhalation. 

Water  contaminated  by  sewage  or  the  seepage  from  latrines  has 
been  a  widespread  cause  of  typhoid  fever  and  cholera.  But  this 
danger  is  so  obvious  and  now  so  well  understood  that,  it  can  be 
assumed,  few  officers  will  allow  their  men  to  drink  water,  not  de- 
clared safe  by  the  sanitary  officer,  without  previous  sterilization  or 
filtration.  Flies  are  also  an  active  agent  of  infection,  carrying  thou- 
sands of  germs  in  the  minute  particles  of  excreta  adhering  to  their 
feet.  Another  prolific  cause  of  the  spread  of  typhoid  fever,  and 
probably  cholera  and  dysentery,  in  camps,  is  personal  contact,  that 
is,  the  dissemination  of  fecal  matter  from  man  to  man,  through  the 
clothing,  shoes  and  hands.  Human  excrement,  therefore,  must  al- 
ways be  looked  upon  with  great  suspicion,  as  a  menace  to  the  health 
of  the  camp,  and  be  the  object  of  the  strictest  sanitary  measures. 

The  methods  of  excreta  disposal  in  camp,  wherever  water  carriage 
is  not  provided  for,  are:  trenches,  pits  or  sinks,  post  holes,  sanitary 
troughs  and  incineration. 

The  ideal  disposal  of  excreta  in  camp  is  incineration.  When  this 
is  not  possible,  the  next  best  method  is  disinfection  and  removal  (by 

636 


LATRINES.  637 

sanitary  trough  and  excavator).  But  in  temporary  camps,  where 
troops  remain  only  for  a  night  or  a  few  days,  or  whenever  the  neces- 
sary sanitary  appliances  are  not  at  hand,  no  better  system  has  yet 
been  devised,  and  probably  ever  will  be,  than  the  primitive  trench  or 
pit.  Whenever  troops  go  into  camp,  even  if  only  for  a  few  hours, 
latrines  are  necessary,  for,  if  not  provided,  the  surrounding  grounds 
will  surely  be  polluted  with  fecal  deposits. 

STRADDLE  TREXCHES. —  For  a  day  or  two,  a  mere  trench,  such  as 
used  by  European  armies,  the  width  of  the  spade  or  shovel  (not  to 
exceed  one  foot)  and  a  depth  of  one  or  two  feet,  is  generally  suffi- 
cient. The  men  squat  astride  of  it,  in  complete  security.  No  pole 
and  supports  are  necessary,  and  there  is  very  little  danger  of  foul- 
ing the  edges.  Furthermore,  everybody  admits  that  the  squatting 
posture  is  conducive  to  a  better  physiological  performance  of  the 
act  of  defecation. 

Shallow  trenches  possess  advantages  over  deep  pits.  They  are 
more  easily  dug  and  taken  care  of,  give  off  less  odor  and  admit 
of  greater  privacy.  The  excreta  being  more  exposed  to  air  and 
bacteria  are  more  promptly  nitrified  and  disintegrated ;  they  are 
less  likely  to  contaminate  the  subsoil  and  the  water-supply. 
Trenches  can  often  be  dug  where  pits  would  be  impossible,  as  in 
shallow  rocky  ground,  in  sandy  soil  liable  to  cave  in,  or  in  low  places 
where  the  ground  water  is  near  the  surface.  The  objections  against 
them  are :  the  larger  area  of  land  required  and  the  necessity  of  dig- 
ging new  ones  once  or  twice  a  week ;  flies  readily  breed  in  them ; 
pollution  of  the  shoes  is  more  likely ;  toilet  paper  is  more  liable  to 
be  blown  about ;  and  the  contents  are  more  exposed  to  be  washed 
out  by  a  heavy  rain. 

In  the  English  Army,  where  this  system  has  been  best  studied  and 
applied,  the  trenches  are  3  feet  long,  i  foot  wide  and  2  or  3  feet 
deep,  each  trench  being  intended  to  be  used  by  one  man  at  a  time. 
The  earth  and  sod  are  heaped  up  at  one  end,  not  at  the  side.  The 
interval  between  the  parallel  trenches,  edge  to  edge,  is  3  feet,  thus 
leaving  sufficient  room  for  a  second  set  when  the  first  is  filled  up. 
In  this  way  there  is  always  an  interval  of  3  feet  between  the  trenches 
in  actual  use.  The  new  rows  are  dug  on  the  side  nearer  to  camp  so 
that  the  men  need  not  walk  over  the  old  trenches.  A  distance  of 
one  foot  is  left  between  the  ends,  as  between  the  sides,  so  that  in 
determining  the  area  required  for  a  given  number  of  trenches,  2  feet 


638 


MILITARY    HYGIENE. 


in  width  and  4  in  length  must  be  allowed  for  each.  As  a  rule,  5 
trenches  are  provided  for  every  100  men,  but  3  or  4  are  enough, 
according  to  Melville,  for  commands  exceeding  500  men.  With  a 
depth  of  2  feet  and  good  management  a  trench  can  be  used  3  or  4 
days.  With  a  depth  of  3  or  4  feet  it  can  be  used  a  week.  In 
Europe,  however,  trenches  seldom  exceed  a  depth  of  2  feet,  as  it  is 
considered  better  to  increase  their  number  than  their  depth. 

In  this  country,  trenches,  although  never  depended  upon  as  a 
permanent  system  of  disposal,  are  frequently  used  as  a  temporary 
device ;  for  instance,  after  a  command  gets  into  camp  and  before 
suitable  pits  are  constructed  (see  page  637). 

Whenever  a  camp  is  not  to  last  more  than  3  or  4  days,  trenches 
will  answer  every  purpose  and  pits  are  unnecessary.  Their  number, 
size  and  arrangement  should  be  as  in  the  English  system,  except 
that  inasmuch  as  only  one  set  will  be  required,  the  interval  between 
them  admits  of  greater  variation ;  as  a  general  rule  it  should  not  be 
less  than  one  foot  nor  more  than  two  feet. 

Each  man  must  immediately  cover  his  fecal  discharges  with  earth, 
suitable  shovels  being  provided  for  the  purpose.  The  trenches  are 
fired  with  crude  petroleum  in  the  same  manner  as  pit  latrines,  or  at 
least  sprinkled  with  it  to  keep  flies  away.  When  the  contents  are 
within  4  or  5  inches  of  the  surface  they  are  filled  with  earth  and  the 
sod  carefully  replaced  and  pressed  down.  It  is  a  good  practice,  be- 


FIG.  209. —  The  Patterson  trench  cover. 


LATRINES. 


639 


fore  leaving  camp,  to  scorch  the  area  used  for  trenches  with  petro- 
leum, so  that  all  exposed  infectious  matter  may  be  destroyed  and 
the  area  itself  clearly  marked  for  the  information  of  other 
commands. 

Patterson,  M.  C.,  U.  S.  A.,  recommends  a  "  straddle-trench 
cover"  (Mil  Surg.,  June,  1913).  Two  planks,  8  inches  wide  and 
6  feet  8  inches  long,  are  nailed,  10  inches  apart,  on  4  cross-pieces  of 
2  by  4  timber.  The  space  between  them  is  closed  in  the  middle,  but 
forms  an  opening  2  feet  long,  at  each  end,  for  defecation.  Each 
cover  is  intended  for  two  men  and  placed  over  a  trench  six  feet 
long.  The  lids  are  hinged  at  the  terminal  end  of  the  opening,  so 
that  if  two  men  use  the  trench  at  the  same  time  they  face  each  other 
(Fig.  209).  It  would  be  preferable  to  have  one  of  the  lids  hinged 
at  the  central  end  of  the  opening  so  as  to  be  interposed  between  the 
two  men.  Two  such  covers  will  usually  be  ample  for  a  company. 

This  cover  being  light  and  easily  handled  will  practically  do  for 
marching  commands  what  is  accomplished  by  the  latrine  box  for 
maneuver  or  semi-permanent  camps,  and  obviate  most  of  the  objec- 
tions mentioned  above. 

Major  Lucas,  N.  G.  N.  Y.,  has  developed  this  type  of  straddle 

«. io'4~ —  —  -      -  -; 

J-j, 30' f 30" r J0~  ~  -T^W  3°'~~"f{ ' 


FOOT 


3  ^  'DOO* 


_j 


FIG.  210. —  The  Lucas  trench  cover. 


640  MILITARY    HYGIENE. 

trench  cover  so  as  to  make  it  more  practically  useful  in  camps  (Mil. 
Surg.,  Dec.,  1916).  Fig.  210  shows  plan  and  section  of  a  trench 
10  feet  long,  with  4  lids.  Each  man  squats  with  back  against  his 
lid,  and  is  thus  screened  from  the  other  men.  The  lid  is  prevented 
from  opening  to  a  greater  angle  than  85  degrees  to  insure  its  auto- 
matic closure  after  use. 

PIT  LATRINE  OR  SINK. —  If  the  camp  is  to  last  more  than  a  few 
days,  pit  latrines  (in  the  absence  of  incinerators)  are  indicated.  If 
they  are  not  to  be  used  more  than  a  week,  a  depth  of  4  or  5  feet  is 
sufficient.  If  needed  for  a  longer  period,  the  pit  must  be  dug  full 
depth ;  this  will  vary  according  to  the  nature  and  composition  of  the 
subsoil  and  underlying  strata,  and  also  the  depth  of  the  ground 
water.  A  shallow  pit. may  be  imposed  by  a  rocky  stratum,  loose 
sandy  soil  with  tendency  to  cave  in,  or  by  the  ground  water  rising 
near  the  surface. 

It  should  be  borne  in  mind  that  the  deeper  the  pit  the  greater  is 
the  danger  of  contaminating  the  ground  water  and,  therefore,  any 
source  of  water-supply  in  the  near  vicinity,  and  the  further  fact  that 
the  nitrifying  bacteria,  through  whose  agency  fecal  matter  is  dis- 
integrated and  mineralized,  are  mostly  in  the  upper  3  or  4  feet  and 
that  their  action  is  very  feeble  below  a  depth  of  6  feet.  However, 
considerations  of  convenience  and  economy  of  space  and  labor  make 
it  generally  advisable  that,  whenever  possible,  the  depth  of  the  pit 
should  be  at  least  7  or  8  feet.  A  convenient  average  width,  for  open 
pits,  is  3  feet  at  the  mouth  and  2  feet  at  the  bottom  ( Fig.  211).  For 
boxed  pits,  the  width  does  not  usually  exceed  2  feet  at  the  mouth. 
In  order  to  increase  the  capacity  of  the  pit,  the  walls  should  be  as 
nearly  perpendicular,  and  the  bottom  as  wide,  as  the  nature  of  the 
soil  safely  permits. 

Sinks  should  never  be  located  in  the  lower  part  of  the  camp  where 
they  are  liable  to  contaminate  ground  water,  and  exposed  to  be 
flooded  in  rainy  weather ;  as  a  rule  they  must  be  on  as  high  grounds 
and  as  far  away  from  the  water-supply  as  possible. 

The  length  of  the  sink  must  be  such  as  to  afford  accommodation 
for  from  5  to  8  per  cent,  of  the  command.  Under  normal  conditions 
the  smaller  of  these  percentages  will  suffice,  but  as  outbreaks  of 
bowel  complaints  may  occur  at  any  time  it  is  better  to  make  more 
liberal  provision  if  conditions  permit.  By  allowing  two  feet  to  each 
man,  a  trench  20  feet  long  will  seat  10  men,  or  about  8  per  cent,  of 


LATRINES. 


641 


FIG.  211. —  Construction  of  pit  latrine. 

an  infantry  company  at  its  maximum  strength  of  128  men.  But 
even  with  a  larger  company,  seldom  will  more  than  4  or  5  men,  as 
a  rule,  visit  the  latrine  simultaneously  for  defecation ;  at  this  rate, 
at  least  40  an  hour  can  be  accommodated,  or  more  than  200  before 
noon. 

To  the  above  length  of  20  feet  should  be  added  4  feet  to  provide 
for  2  urinals,  one  at  each  end,  as  explained  further  on. 

The  question  suggests  itself  whether  each  company  should  have 
its  separate  sink  or  if  it  fs  not  preferable  to  have  only  one  longer 
trench  for  the  battalion.  The  latter  system  is  certainly  economical 
of  time,  labor  and  space ;  it  is  easier  to  dig  one  trench  80  feet  long 
than  four  separate  ones  20  feet  long;  but,  on  the  other  hand,  the 
shorter  pits  can  be  placed  nearer  their  respective  organizations  and 
maintained  in  a  more  perfect  state  of  police.  The  question  will  be 
largely  determined  by  the  local  conditions  of  terrain,  soil,  ground 
water  and  by  the  form  of  the  camp.  A  very  satisfactory  compromise 
is  to  have  one  trench  for  each  two  companies,  with  brush  partition 
across  the  middle. 

In  digging  the  pit,  the  excavated  material  is  usually  piled  along 
the  edge  of  the  rear  side.  This  material,  or  as  much  of  it  as  is  good 
for  the  purpose,  will  be  used  as  disinfectant ;  it  is  desirable,  there- 
fore, if  a  notable  proportion  of  it  should  consist  of  coarse  gravel. 


642  MILITARY    HYGIENE. 

chalk  or  stone,  to  throw  it  further  back  and  pile  the  loam  and  other 
available  earth  along  the  edge  of  the  pit. 

The  usual  latrine  seat  is  made  up  of  a  smooth,  straight  pole  or 
sapling,  with  bark  shaved  off  if  possible,  resting  upon  crossed  logs. 
These  supports  are  placed  at  intervals  of  7  or  8  feet,  each  set  con- 
sisting of  two  logs  planted  opposite  each  other,  one  in  each  edge, 
and  crossing  at  such  a  slant  that  the  apex  of  the  upper  angle  which 
they  form  is  about  15  inches  above  the  mouth  of  the  pit,  on  a 
vertical  line  falling  about  8  inches  in  the  rear  of  the  front  edge ;  in 
this  position  they  are  securely  lashed  or  otherwise  fastened  together. 
Besides  the  seat  pole  placed  in  the  angle  of  the  supports,  another 
horizontal  pole  must  be  secured  to  the  front  logs,  as  foot  rest  and 
protection  to  the  front  edge,  just  high  enough  to  clear  the  ground. 
The  front  logs  (planted  in  front  edge),  must  be  at  least  4,  and  the 
rear  ones  (planted  in  rear  edge),  5  feet  long.  (Fig.  211.) 

Whenever  the  pit  need  not  be  more  than  5  or  6  feet  long,  the 
seat  pole  is  made  to  rest  on  the  forks  of  two  upright  poles,  one 
planted  at  each  end. 

One  part  of  the  pit  must  be  reserved  for  urination,  preferably  one 
end  or  both  ends  of  it.  For  this  purpose  the  crossed  poles  holding 
the  seat  should  be  set  in  a  couple  of  feet  from  the  ends ;  the  space 
thus  set  apart  as  urinal  may  be  still  further  isolated  by  a  brush  parti- 
tion thrown  across  the  trench.  The  passing  of  urine  which  accom- 
panies defecation  necessarily  takes  place  in  the  latrine  but,  at  any 
other  time,  urination  in  any  places  but  those  specially  prepared  and 
designated  must  be  strictly  prohibited.  Thus  only  can  the  edges  and 
surrounding  of  the  latrine  be  guarded  against  urine  pollution. 

The  last  requisite  to  make  the  sink  complete  is  a  draining  ditch 
around  it,  or  at  least  on  the  sides  from  which  drainage  water  might 
be  expected.  This  is  very  important ;  otherwise  a  heavy  rainfall 
may  flood  the  trench,  scatter  its  contents  over  surrounding  grounds 
and  do  irreparable  harm. 

Latrines  should  be  given  as  much  privacy  as  possible  by  building 
a  wall  of  canvas  or  of  brush,  6  feet  high,  around  them.  As  to  over- 
head protection  against  sun  and  rain,  experience  at  the  San  Antonio 
camps,  in  1911,  has  shown  that,  contrary  to  the  ideas  then  prevailing, 
the  latrines  left  unprotected  are  more  distinctly  free  from  odors  and 
flies  than  those  which  are  covered  over;  in  other  words,  that  a 
bright  light  tends  to  inhibit  putrefaction  and  acts  as  an  insectifuge. 


LATRINES.  643 

Therefore  only  in  case  of  persistent  rain  would  the  use  of  a  tent  fly 
or  other  shelter  be  advisable. 

LATRINE  Box.  —  Whenever  a  camp  is  to  assume  a  permanent  or 
semi-permanent  status,  the  Regulations  provide  special  systems  of 
disposal  as  described  below.  But  in  war  time,  during  a  campaign, 
particuarly  in  a  foreign  country,  owing  to  the  great  difficulty  of 
transportation,  the  use  of  such  cumbrous  appliances  will  generally 
be  impracticable  and  sinks  made  necessary  for  indefinite  periods  of 
time.  The  question  is  then  how  to  render  these  sinks  as  little 
objectionable  and  harmful  as  possible.  There  is  a  consensus  of 
opinion  that  they  should  be  "  boxed  "  so  as  to  convert  them  into 
close  vaults  more  easily  policed  and  from  which  flies  can  be 
excluded. 

Boxed  latrines  have  now  been  used  in  our  service  for  several 
years  in  many  camps,  and  there  is  unanimous  agreement  as  to  their 
great  superiority  over  the  open  sink  in  regard  to  convenience,  com- 
fort and  disease  prevention.  The  cost  of  their  construction  and 
operation  is  so  very  much  less  than  that  of  incinerators  (i  to  30), 
while  their  simplicity,  mobility  and  quickness  of  installation  are  so 
much  greater  that,  although  theoretically  inferior  to  them  as  a 
means  of  excreta  disposal,  they  are  to  a  large  extent  superseding 
them,  experience  having  shown  that  they  can  be  safely  and  success- 
fully used  for  long  periods  of  time  in  permanent  camps. 

Latrine  boxes  should  be  designed  according  to  uniform  standards, 
so  that  they  may  be  readily  constructed  wherever  needed.  They 
should  be  light  and  portable,  yet  strong  and  tight-jointed  so  as  to 
endure  rough  handling  and  exclude  insects.  The  seat  holes  must 
be  provided  with  self-closing  lids  so  that  they  may  never  be  left 
open,  and  also  to  prevent  men  from  squatting  on  the  seat  instead 
of  sitting  down  during  defecation.  The  principal  reason  for  not 
leaving  the  holes  uncovered  is  that  flies  and  other  insects  may  not 
enter.  Therefore  if  flies  are  absent,  as  in  winter  and  early  spring, 
and  the  latrine  is  sheltered  from  rain,  lids  may  be  dispensed  with. 

Several  types  have  been  advocated.  The  simplest  is  a  row  of 
seats  with  lids,  the  sides  and  ends  consisting  of  cotton  sheeting 
extending  to  the  ground  and  secured  by  tent  pins.  This  skeleton 
box  can  be  made  folding  or  knock-down  for  transportation. 

The  knock-down  latrine  box  devised  by  the  writer  is  10  feet  6 
inches  long,  16  inches  high  and  3  feet  8  inches  wide  at  bottom  so 


644 


MILITARY    HYGIENE. 


as  to  safely  cover  a  pit  3  feet  wide  (Fig.  212).  The  sides  or  walls 
have  an  outward  slant  of  4  inches  and  are  locked  together  by  the 
end  pieces  and  two  traverses.  The  top  consists  of  two  longitudinal 
halves,  simply  laid  on  and  kept  from  slipping  by  blocks;  each  21 
inches  wide,  projecting  2  inches  beyond  the  side,  and  perforated  by 
3  holes  which  alternate  with  those  of  the  other  half.  Each  hole, 
ii  inches  long,  is  covered  with  a  strong  hinged  lid  which  can  only 
be  raised  to  an  angle  of  60°,  so  that  it  is  self-closing  and  prevents 
standing  on  the  edge  of  the  box. 


FIG.  212. — The  Havard  knock-down  box,  with  one-half  of  the  top  shifted 
over  the  other  half  for  inspection  and  disinfection. 

Each  box  consists  of  8  pieces  perfectly  interchangeable  with  those 
of  any  other  box,  and  weighs  175  pounds.  It  is  put  together  without 
screw,  bolt  or  hook,  or  taken  apart,  by  one  or  two  men  in  a  few 
moments.  To  disinfect  the  pit,  the  attendant  lifts  the  half  of  the 
top  nearest  to  the  earth  pile  and  shifts  it  over  the  other  half,  thus 
uncovering  the  pit  and  obtaining  a  good  view  of  the  contents.  One 
pit  10  feet  long  covered  with  this  box  will  do  for  a  company  for 
a  week  or  two ;  if  the  stay  is  to  be  longer,  the  pit  should  be  of  the 
standard  length  of  20  feet  and  2  boxes  used,  end  to  end. 


LATRINES.  645 

This  knock-down  type  of  box  has  never  been  tested  on  a  sufficient 
scale  to  determine  what  its  real  merits  in  the  field  may  be,  or  how  it 
could  be  perfected.  The  present  tendency  of  our  military  hygienists 
is  in  favor  of  a  solid,  nailed-together  box,  with  a  single  row  of  holes. 
One  of  this  type,  devised  by  Major  P.  F.  Straub  (Mil.  Surg.,  Dec., 
1911),  was  used  in  the  San  Antonio  camps,  in  1911,  with  very 
satisfactory  results.  It  is  10  feet  long,  with  5  holes,  made  of 
tongue-and-groove  lumber  and  designed  to  cover  a  pit  2  feet  wide. 
The  vertical  front  is  18  inches  high,  and  the  top  20  inches  wide ; 
the  back  slants  outward  so  as  to  increase  the  bottom  width  to  30 
inches.  The  circular  holes  are  9  inches  in  diameter,  and  covered 
by  a  solid  lid  12  inches  wide,  reinforced  by  two  battens  (i"x2w) 
to  prevent  warping  and  to  which  the  hinges  are  fastened.  Longi- 
tudinal strips  (i"x2")  on  the  rear  edge  prevent  the  lid  from  being 
raised  to  a  right  angle,  so  that  it  falls  back  automatically. 

Major  Wm.  Lyster  (Mil.  Surg.,  May,  1912)  proposes  a  similar 
box  but  differing  in  several  particulars  (Fig.  213).  It  is  only  8 
feet  long,  with  4  holes,  and  is  provided  with  a  grip  at  each  end  for 
convenience  of  handling.  The  top  is  18  inches  wide,  with  slope  of 
1 1/2  inch  to  the  rear  to  drain  rain  and  wash  water.  The  circular 
holes  are  n  inches  in  diameter.  The  lid  is  extended  forward,  flush 
with  the  top  edge  so  as  to  keep  the  seat  dry.  and  has  a  block  nailed 
on  the  upper  side  to  prevent  its  opening  to  a  right  angle.  A  block 
(2"x3")  is  nailed  at  each  end  of  the  upper  edge  in  front,  so  that 
when  the  box  is  turned  over,  this  edge  may  not  be  soiled  or 
scratched.  A  piece  of  tin,  8  feet  by  10  inches,  is  fastened  by  its 
upper  edge  to  the  inside  of  the  front  wall,  opposite  each  seat,  and 
set  at  an  angle  that  causes  the  urine  projected  against  it  to  fall  clear 
into  the  pit.  An  important  adjunct  to  the  Lyster  box  is  a  frame 
upon  which  it  is  set,  so  as  to  make  the  contact  with  the  ground 
closer.  To  hold  the  box  on  the  frame,  a  strip  of  board,  4  inches 
wide,  is  nailed  one  inch  inside  the  lower  edge  of  the  box,  thus  pro- 
jecting 3  inches  clear,  and  snugly  fitting  inside  the  frame.  It  is 
certain  that  such  a  frame  renders  the  box  more  completely  fly-proof 
and  protects  the  edges  of  the  pit  from  wear  and  tear ;  on  the  other 
hand,  it  adds  materially  to  its  weight  and  complexity  and  may  in- 
terfere with  the  proper  aeration  of  the  pit. 

The  Q.  M.  Corps,  availing  itself  of  previous  investigations  by 
medical  officers  and  others,  has  published  the  plans  of  its  standard 


646 


MILITARY    HYGIENE. 


FIG.  213. —  The  Lyster  latrine  box. 

latrine  box  (Man.  for  the  Q.  M.  Corps,  1917),  combining  most  of 
the  desirable  features  hitherto  recommended  (Fig.  214).  This  box 
rests  on  a  frame,  and  has  4  seats.  It  is  8  feet  long,  17  inches  high 
and  22  wide  on  top.  The  holes  are  oval  in  shape,  10  by  13  inches. 
The  lid  is  14  inches  wide,  bearing  an  oval  piece  beneath  made  to  fit 
the  hole,  and  prevented  from  opening  to  a  right  angle  by  a  block 
nailed  to  the  upper  side.  A  piece  of  tin,  7  feet  by  10  inches,  is 
fastened  to  the  front  wall  as  advised  by  Lyster.  (Fig.  215.) 

Some  general  desiderata  may  be  thus  stated :  All  boards  used 
should  be  well  seasoned,  tongued  and  grooved,  and  of  a  uniform 
width  of  6  inches ;  the  timbers  to  be  2  by  4  inches.  The  best  shape 
for  the  seat  hole  is  not  circular  but  ovoid,  8  by  n  inches  in  size. 
The  lid  should  be  12  inches  wide,  of  one  solid  piece  or  of  two  pieces, 
and  stiffened  by  one  or  two  battens  to  prevent  warping.  To  make 
it  self-closing,  the  easiest  way  is  by  the  use  of  a  stop  block,  as  in 
the  standard  box.  Finally,  it  should  be  possible  to  secure  the  lid 
so  that  when  the  box  is  turned  over  for  disinfection  of  the  pit,  or 


LATRINES. 


647 


PLAN 


FIG.  214. —  Standard  latrine  box.     Quartermaster  Corps. 


FIG.  215. —  Section  of  standard  box. 

carried  about,  it  may  not  swing  open.  This,  with  lid  flush  with  the 
upper  edge,  as  it  should  be,  is  easily  done  by  means  of  a  hook  (on 
box)  and  small  screw-eye  (on  lid). 

The  ventilation  of  the  boxed  latrine  also  deserves  attention.  Good 
ventilation  is  necessary  to  favor  the  work  of  the  aerobic  bacteria 
and  thus  prevent  the  production  of  putrefactive  odors.  It  also  helps 
the  evaporation  of  moisture,  preventing  its  condensation  on  the 
under  surface  of  the  lid  and  the  edges  of  the  holes.  Therefore  it 
is  not  desirable  to  make  the  box,  or  its  contact  with  the  ground, 
impervious  to  air,  but  simply  tight  enough  to  exclude  flies.  With 
efficient  disinfection,  special  ventilation  is  seldom  called  for ;  when 
this  becomes  desirable  on  account  of  unpleasant  odors,  a  good 
method  is  to  cut  a  round  hole,  4  inches  in  diameter,  at  or  near  the 
center  of  the  top,  guarded  (when  not  used)  by  a  sliding  lid,  and  ad- 
mitting a  tin  pipe  5  or  6  feet  high.  This  pipe  should  be  screened 


648  MILITARY    HYGIENE. 

at  the  top  and  bear  a  flange  about  6  inches  from  the  lower  end  to 
keep  it  from  sliding  further  down.  A  pipe  of  tar  paper  may  also 
be  improvised,  with  a  piece  of  loose-meshed  muslin  tied  at  top.  A 
simpler  method  of  ventilation,  and  perhaps  as  efficient,  is  to  provide 
a  screened  opening,  6  inches  wide  and  long,  in  each  end  of  the  box. 

Inasmuch  as  a  latrine  box  does  not  permit  direct  urination  into 
the  pit  (outside  of  defecation),  some  special  urinal  must  be  pro- 
vided outside  of  it.  The  best  device  is  a  galvanized-iron  trough 
6  or  8  feet  long,  supported  by  cross  sticks.  At  one  end  of  it  is  a 
projecting  collar  upon  which  fits  the  outlet  tin  pipe.  This  pipe 
should  run  down,  under  the  edge  of  the  box,  into  the  pit,  rather 
than  through  a  hole  cut  in  the  end  of  the  box.  Tar  paper  or  painted 
muslin  are  convenient  materials  with  which  to  improvise  urinals  and 
pipes,  the  urinals  in  the  shape  of  troughs  supported  on  forked  sticks 
or  of  funnels  suspended  from  tripods.  Wooden  boxes  and  gutters 
may  also  be  available.  If  none  of  these  materials  be  at  hand,  a 
shallow  trench,  partly  filled  with  stones  or  gravel  must  be  used. 

Urine  or  water  in  latrines  interfere  more  or  less  with  the  action 
of  nitrifying  bacteria  and  favor  putrefactive  decomposition ;  this  is 
particularly  the  case  when  earth  is  mostly  relied  upon  for  disinfec- 
tion. It  is  therefore  preferable,  whenever  convenient,  to  separate 
the  urine  from  the  feces.  This  is  readily 'accomplished  by  running 
the  outlet  pipe  of  the  urinal  into  a  hole  dug  with  the  post-hole 
auger,  the  lower  end  of  the  pipe  fitting  through  an  opening  in  a 
board  covering  the  hole.  A  pit  urinal  (see  page  652)  may  also  be 
used. 

Police  and  Disinfection. —  In  order  to  promote  personal  cleanliness 
and  prevent  as  much  as  possible  the  transmission  of  infection  by 
personal  contact,  the  men  should  be  enjoined  to  use  paper  in  latrines, 
preferably  the  ordinary  thin  toilet  paper.  The  Regulations  provide 
for  the  issue  of  toilet  paper  in  camps  whenever  practicable.  The 
use  of  paper,  however,  especially  light  tissue  paper,  requires  great 
care ;  the  least  breeze  will  often  prevent  its  falling  into  the  sink, 
while  a  stronger  wind  may  blow  it  up  and  scatter  it  over  the  camp 
grounds.  This  is  much  less  likely  in  boxed  than  in  open  sinks. 

Another  important  measure  to  prevent  fecal  matter  dissemination 
is  to  require  the  men  to  wash  their  hands,  after  defecation,  before 
leaving  the  latrine  shed.  For  this  purpose,  the  attendant  (whenever 
practicable)  should  have  a  bucket  of  clean  water,  a  couple  of  basins 


LATRINES.  649 

and  soap  always  in  readiness,  each  man  after  washing  emptying  his 
waste  into  the  urinal.  When  an  infectious  disease  is  present  in 
camp  or  vicinity,  it  will  be  wise  to  dip  the  hands,  before  washing 
them,  into  an  antiseptic  solution  of  formalin,  cresol,  corrosive  sub- 
limate, etc.  During  one  of  their  wars  with  the  natives  in  South 
Africa,  German  troops  were  required,  after  defecation,  to  soak 
their  hands  in  an  antiseptic  solution  and,  after  washing,  to  wipe 
them  with  dry  sand.  This  care  of  the  hands  will  be  greatly  facili- 
tated by  locating  the  lavatory  as  close  to  the  latrine  as  possible. 

Strict  cleanliness  and  efficient  disinfection  will  prevent  much  of 
the  danger  lurking  in  the  open  sink.  In  the  first  place,  it  should 
be  in  charge  of  a  civilian  scavenger,  or  enlisted  attendant,  perma- 
nently detailed  if  possible  and  held  strictly  responsible  for  its  sani- 
tary condition.  Every  man  using  it  must  be  required  to  cover  his 
discharges  with  a  shovelful  of  earth.  Furthermore,  the  attendant 
twice  a  day,  or  oftener  if  deemed  necessary,  should  make  an  exami- 
nation of  the  contents  and  throw  earth  on  any  part  of  the  surface 
not  properly  covered,  not  neglecting  the  fecal  matter  adhering  to 
the  walls.  When  earth  is  not  available,  lime  may  be  used,  but  it 
should  be  one  or  the  other,  not  a  mixture  of  both.  Earth  is  a 
deodorant  and  disinfectant ;  it  absorbs  offensive  gases  to  a  remark- 
able extent  and  brings  about  their  oxidation  and  transformation ;  it 
promotes  the  multiplication  of  saprophytic  bacteria  and  nitrifying 
organisms  which  feed  actively  upon  all  available  organic  matter 'and 
destroy  it,  with  the  result  that  they  themselves  speedily  perish  from 
lack  of  nourishment.  Lime  acts  by  destroying  these  organisms  or 
preventing  their  propagation ;  therefore,  if  mixed,  these  agents 
would  partly  neutralize  each  other  and  lose  much  of  their  efficiency. 

The  attendant  should  daily  scrub  the  seat  with  soap  and  water, 
and  carefully  police  the  edges  of  the  pit  and  urinals,  sprinkling  lime 
wherever  fouling  has  taken  place.  One  of  his  chief  duties  will  be 
to  see  that  toilet  paper  escaped  from  the  latrine  is  promptly  returned 
to  it  or  otherwise  safely  disposed  of.  The  easiest  solution  of  this 
troublesome  difficulty  is,  occasionally,  to  light  a  small  open  fire  in 
which  all  loose  paper,  caught  with  a  pointed  stick,  is  readily 
consumed. 

Firing  of  Pits. —  Of  late  years,  disinfection  by  fire  has  been  found 
so  satisfactory  as  to  be  always  preferred  whenever  applicable.  The 
method  is  as  follows :  At  about  9  o'clock  A.  M.,  after  a  majority 


650  MILITARY    HYGIENE. 

of  the  men  have  visited  the  latrine,  the  box  being  lifted  to  one  side, 
a  layer  of  straw,  grass  or  hay  (10  or  15  pounds  for  a  pit  10  feet 
long)  is  evenly  spread  over  the  contents,  sprinkled  with  a  gallon 
of  crude  petroleum  and  set  on  fire.  The  hot  blaze  destroys  all  the 
germs  lying  near  the  surface  of  the  excreta  as  well  as  on  the  sides 
of  the  pit,  and  completely  removes  all  odors.  It  tends  to  keep  the 
flies  away,  and  prevents  their  laying  eggs  on  the  scorched  and 
hardened  feces.  All  loose  toilet  paper  is  also  burned  up.  Straub 
believes  that  still  better  results  would  be  obtained  by  using  oil  alone, 
in  increased  quantity  (by  an  additional  quart),  as  the  residue  from 
burned  hay  or  straw  fills  the  pit  uselessly.  The  effect  of  the  firing 
decreases  in  the  afternoon,  and  odors,  especially  on  warm  days, 
are  likely  to  be  again  noticeable;  then  a  liberal  coating  of  lime  is 
recommended,  or  of  fine  dry  earth.  Crude  petroleum  or  diluted 
formalin  sprinkled  into  the  pit  is  useful  at  any  time  as  disinfectant 
and  insectifuge. 

The  box  itself  demands  attention.  Before  being  replaced  upon 
the  pit  the  interior  is  whitewashed  with  milk  of  lime  so  far  as  may 
be  needful.  The  seats  must  be  daily  scrubbed  and  kept  scrupulously 
clean. 

Spraying  of  Pits. —  With  the  recent  great  increase  in  the  size  and 
number  of  our  camps  there  has  been  a  decided  tendency  to  reduce 
the  complexity  and  cost  of  our  sanitary  methods.  The  firing  of  pits 
requires  a  notable  expenditure  of  time,  work  and  material,  and 
efforts  have  been  made  to  obtain  the  same  results  in  a  simpler  and 
cheaper  way.  Recent  experiments  have  shown  that  this  is  possible. 

Major  Montgomery,  N.  G.  N.  Y.,  was  one  of  the  first  medical 
officers  to  show  that  spraying  the  pit  with  a  mixture  of  kerosene 
and  lamp-black,  without  burning,  is  all  that  is  required.  Bone- 
black  is  cheaper  than  lamp-black  and  can  be  substituted.  It  is  well 
known  that  black  is  a  deterrent  to  flies  and  that  they  will  not  light 
upon  a  surface  so  treated. 

Major  Miller,  M.  C,  U.  S.  A.,  describes  this  new  method  as  fol- 
lows (The  Mil.  Surgeon,  May,  1917)  : 

"  In  the  El  Paso  district  the  practice  of  burning  out  latrine  pits  has 
been  entirely  discontinued.  The  routine  now  carried  out  is  as  fol- 
lows: When  the  latrine  is  first  established  the  inside  of  the  box 
and  the  sides  of  the  pit  are  thoroughly  blackened  with  a  mixture 
of  i  pound  of  bone  black  in  3  gallons  of  crude  oil  For  this  purpose 


LATRINES.  651 

a  spray  pump  is  issued  to  each  regiment.  This  application  to  the 
sides  of  the  pit  and  to  the  inside  of  the  latrine  box  is  repeated  once 
in  ten  days.  In  addition  to  the  above  the  contents  of  the  pit  are 
thoroughly  covered  each  day  with  il/2  gallons  of  the  boneblack-oil 
mixture,  using  an  ordinary  sprinkling  pot  for  the  purpose.  With  a 
reasonably  tight  box,  flies  will  not  enter  a  pit  so  treated.  Provided 
the  pit  is  not  used  as  a  receptacle  for  waste  paper  and  other  rubbish 
it  will  not  be  so  quickly  filled  under  this  treatment  as  when  burn- 
ing is  resorted  to.  Another  advantage  of  this  method  of  latrine 
management  is  that  it  is  applicable  to  pits  that  are  shored  up  with 
lumber  to  prevent  caving  and  to  those  containing  water  either  from 
seepage  or  flooding.  Some  experiments  have  been  conducted  to 
determine  whether  bone  black  is  necessary  in  the  oil  used  for  the 
daily  sprinkling.  Definite  conclusions  have  not  been  arrived  at  in 
regard  to  this  point." 

It  is  quite  probable  that  further  experience  will  show  that  the 
amount  of  oil  used  in  the  daily  sprinkling  can  be  materially  reduced. 
Thus  Major  Montgomery  obtained  excellent  results  with  half  a  gal- 
lon or  less. 

It  is  also  believed  that  incineration  destroys  the  nitrifying  bacteria 
to  a  much  greater  extent  than  simple  spraying,  so  that  the  genera- 
tion of  ill-smelling  gases  is  more  likely  in  the  former  method  than 
in  the  latter. 

Urinals  can  be  disinfected  with  lime,  but  scrubbing  with  crude 
petroleum  is  much  more  effective. 

When  a  sink  is  filled  to  within  18  inches  of  the  top,  it  should 
be  discontinued  and  filled  up  with  earth ;  this  should  be  piled  a  few 
inches  above  the  surface  to  allow  for  sinking. 

The  fire  or  spray  disinfection  above  described  requires  large  quan- 
tities of  oil  and  is  therefore  only  applicable  to  more  or  less  perma- 
nent camps.  With  moving  commands,  latrine  boxes  will  generally 
have  to  be  abandoned ;  such  dry  fuel  as  locally  available  may  be 
used,  without  oil,  but,  as  a  rule,  no  other  or  better  disinfectant 
will  be  at  hand  than  the  earth  dug  out  of  the  pits. 

Objections  to  the  pit  latrine. —  These  are  obvious.  We  can  as- 
sume that  pathogenic  germs  may  be  present  at  any  time  in  its  con- 
tents, with  resulting  pollution  of  the  soil  and  subsoil,  and  con- 
tamination of  neighboring  water-courses.  The  germs  of  typhoid 
fever  in  contact  with  soil  and  fecal  matter  may,  under  favorable 


652  MILITARY    HYGIENE. 

conditions,  multiply  or  at  least  remain  alive  for  a  period  of  several 
weeks.  The  pole  used  as  seat  is  much  exposed  to  fouling,  and  so 
are  the  edges  and  immediate  surroundings  of  the  trench,  often 
wetted  by  rain  and  offering  favorable  conditions  for  the  rapid 
growth  of  various  pathogenic  germs.  One  of  the  chief  dangers  of 
the  open  pit  is  its  free  accessibility  to  flies  which  may  thus  easily 
transmit  infective  matter  to  the  kitchen  and  mess  tents.  Toilet 
paper  blown  out  of  it  is  also  a  constant  menace. 

Most  of  these  objections  are  practically  eliminated  by  the  use 
of  a  properly  constructed  box,  and  careful  disinfection.  In  the 
absence  of  incinerators,  latrines,  therefore,  must  always  be  boxed, 
if  possible,  and  open  sinks  used  only  as  a  necessary  evil. 

URINALS. —  Whatever  form  of  latrine  is  used,  it  is  essential  that 
a  special  night  urinal  be  provided.  During  the  day  there  is  no  great 
danger  of  any  one  urinating  outside  the  latrines,  for  fear  of  dis- 
covery, but  at  night,  careless  men  are  strongly  tempted  to  relieve 
themselves  as  near  their  tents  as  is  convenient.  An  iron  can  should 
be  placed  in  each  company  street  as  urinal,  with  a  red  lantern  over 
it,  so  that  no  one  may  have  an  excuse  for  polluting  any  part  of  the 
company  grounds.  This  can  should  be  emptied  and  cleaned  out  at 
reveille.  During  the  day  it  may  be  kept  near  the  latrine  and  used  to 
collect  refuse. 

Whenever  urinals  are  deemed  necessary,  apart  from  latrines,  as, 
for  instance,  when  the  latter  consist  of  narrow  and  shallow  trenches, 
the  post-hole  system  as  described  above  is  generally  available  and 
sanitary.  A  urinal  can  always  be  quickly  improvised  by  digging  a 
circular  pit,  3  feet  deep,  and  filling  it  a  little  more  than  half  full 
with  stones,  clinkers,  ashes,  gravel  or  loose  earth. 

The  urinal  recommended  in  the  English  Army,  for  a  battalion, 
consists  of  a  pit  and  trenches.  The  pit,  3  or  4  feet  in  diameter  and 
depth,  is  loosely  refilled  with  the  excavated  earth  or,  much  better, 
half  filled  with  large  irregular  stones,  tin  cans  or  burned  rubbish, 
covered  over  with  coarse  gravel  and  then  earth  well  rammed  down. 
Into  this  pit,  run  two  trenches  (one  on  each  side)  filled  with  small 
stones,  each  12  feet  long  and  2  feet  wide,  with  gradient  of  one  inch 
to  the  foot.  All  the  urine  is  passed  into  the  trenches,  the  pit  being 
protected,  if  needful,  by  a  fence  or  screen.  As  soon  as  the  trenches 
become  offensive  they  are  filled  up  and  others  dug.  The  urine  is 
led  from  the  trench  to  the  bottom  of  the  pit  by  a  loosely  jointed  pipe 


LATRINES.  653 

of  tin  cans  running  diagonally  down  to  the  further  end.  The  cov- 
ering of  earth  on  the  pit  keeps  flies  away  and  prevents  odors.  The 
weak  points  of  this  system  are  the  extent  of  the  trench  exposed  to 
flies  and  liable  to  give  off  smells,  and  the  splashing  of  the  urine 
with  pollution  of  the  ground  on  both  sides  of  it.  These  objections 
can  be  mitigated  by  a  daily  firing  with  crude  petroleum,  or  removed 
by  the  use  of  tin  or  wooden  troughs,  easily  disinfected. 

POST  HOLES. —  This  method  of  disposal,  first  advocated  by  Major 
William  Jepson,  I.  N.  G.,  has  never  been  extensively  used  in  our 
camps  but,  wherever  resorted  to,  has  given  satisfactory  results.  It 
consists  in  digging  a  series  of  holes,  about  3  feet  apart,  8  or  9 
inches  in  diameter  and  7  to  8  feet  deep,  with  an  ordinary  post-hole 
auger.  A  top,  18  inches  wide,  with  suitable  seat  openings  is  set 
over  them  at  the  proper  height,  each  opening  corresponding  to  a 
hole  and  bearing  a  circular  guard  of  tar  paper,  extending  nearly 
down  to  the  edge  of  the  hole,  to  prevent  scattering  of  urine  and 
feces.  These  guards  should  be  frequently  renewed,  and,  when 
removed,  burned.  On  each  side  of  the  top,  extending  to  the  ground, 
is  a  strip  of  muslin.  In  the  absence  of  flies  neither  muslin  nor  lids 
are  necessary. 

This  latrine,  even  without  the  use  of  earth  or  disinfectant,  is 
said  to  be  remarkably  free  from  offensive  smell.  It  also  permits  a 
greater  degree  of  privacy,  owing  to  the  distance  between  the  holes 
and  the  facility  of  isolating  them  by  screens.  Its  use  may  be  im- 
practicable in  rocky  or  damp  ground,  but  in  most  soils  it  is  a  cheap, 
cleanly  and  safe  method  of  disposal. 

SANITARY   THOUGH  LATRINE  AND  OTHER   SYSTEMS. 

Several  improved  systems  of  disposal  for  permanent  or  semi- 
permanent camps  are  or  have  been  in  use  in  our  service. 

The  sanitary  trough  latrine  was  one  of  the  remarkable  results  of 
the  investigation  of  the  medical  board  appointed  to  determine  the 
causes  of  the  typhoid  fever  epidemics  which  decimated  our  camps 
in  1898.  This  board,  consisting  of  Major  Walter  Reed,  Major 
Victor  C.  Vaughan  and  Major  E.  O.  Shakespeare,  soon  realized 
that  the  open  sinks  were  largely  responsible  for  the  prevailing 
infection  and  recommended  a  system  whereby  all  excreta  are  dis- 
infected and  removed  from  camp. 

The  trough  latrine  (as  described  in  specifications  from  the  office 


654 


MILITARY    HYGIENE. 


of  the  Chief  Quartermaster  Corps,  January,  1908)  consists  of  a 
small,  well-ventilated  frame  building  with  doorless  opening  at  each 
end,  containing  the  trough  and  urinal.  The  trough,  of  galvanized 
iron,  is  14  feet  long  and  22  inches  wide  at  top,  with  sloping  bottom 
15  inches  deep  at  upper  end  and  18  inches  at  lower  end;  it  is  para- 


FIG.  216. —  Perspective  view  of  latrine  trough;   section  of  lid  open. 

bolic  in  cross  section  so  as  to  present  a  curved  surface  throughout, 
thus  avoiding  corners  in  which  the  contents  could  collect  and  facil- 
itating emptying  and  cleaning.  (Fig.  216.)  The  seat  has  7  openings 
and  is  made  of  8  separate  pieces  hinged  to  a  board  in  rear.  The  open- 
ings are  8^2  inches  in  diameter,  properly  bevelled  on  edges,  with  cuts 
in  front  and  rear  to  prevent  fouling,  the  rear  cut  widening  to  14 
inches  at  back.  At  each  end  of  the  seat,  and  flush  with  it,  is  set  up 
an  upright  32^2  inches  high ;  on  these  uprights  is  nailed  a  board 
to  prevent  standing  on  the  seat.  (Figs.  216,  217.) 

The  urinal  is  a  galvanized  rounded  steel  trough  placed  against 
the  rear  end  of  the  building  in  line  with  the  latrine  trough,  2  feet 
6  inches  above  the  floor.  It  is  8  feet  long,  8  inches  wide  and 
4  inches  deep,  the  rear  side  extending  18  inches  upward  to  protect 
the  wall.  It  has  a  fall  of  5  inches  and  is  connected  to  the  latrine 
trough  by  a  2-inch  galvanized  steel  pipe. 

When  ready  for  use,  water  should  be  poured  into  the  latrine  until 
it  has  a  depth  of  at  least  2  inches  at  the  upper  end.  To  this  is  then 


LATRINES. 


655 


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FIG.  217. —  Ground  plan  of  trough  latrine  showing  seats  and  urinal. 

added  one-sixth  barrel  of  lime  and  the  two  well  mixed  with  a 
wooden  paddle.  Lime  should  also  be  freely  sprinkled  in  the  urinal. 
By  this  means  not  only  do  the  excreta  immediately  fall  into  a  disin- 
fectant solution,  but  the  urine  is  also  mixed  with  lime  prior  to  fall- 
ing in  the  latrine.  To  better  provide  for  the  disinfection  of  the 
excreta,  the  contents  of  the  latrine  should  be  stirred  with  a  wooden 
paddle  two  or  three  times  a  day. 

Lime  is  liable  to  clog  the  hose  and  has  no  deterrent  effect  upon 
flies ;  it  is  now  generally  replaced  by  crude  petroleum,  one  quart  in 
the  v.  ater. 

Once  or  twice  a  day  the  trough  is  emptied  by  the  "  orderless  exca- 
vator." This  consists  of  a  wagon  bed  supporting  a  water-tight  tank 
having  a  capacity  of  500  gallons,  and  a  pumping  apparatus  mounted 
on  a  pair  of  wheels  which  track  with  the  wheels  of  the  wagon.  For 
use,  two  lengths  of  hose  are  connected  with  the  pump,  one  at  each 
extremity ;  one  free  end  is  placed  in  the  lower  part  of  the  trough 
through  a  hinged  door  in  the  wall  of  the  building  and  the  other 
free  end  attached  to  the  pipe  on  top  of  the  tank.  The  pump  is  rap- 
idly worked  by  two  men.  As  soon  as  the  trough  is  emptied,  the  hose 
are  disconnected  from  pump  and  tank,  great  care  being  taken  that 
the  ends  of  the  hose  and  the  openings  of  the  pump  are  securely 
closed  by  the  couplings  or  valves  provided  for  the  purpose,  so  that 
none  of  the  contents  be  spilled  on  the  ground.  In  camp  or  on 
march  the  pump  truck  is  hitched  to  the  rear  axle  of  the  wagon. 
Each  excavator  requires  the  services  of  3  men  and  disposes  of  the 
excreta  of  2  or  3  regiments. 

The  sanitary  trough  latrine  possesses  decided  advantages.  It  is 
very  convenient  for  the  men.  It  need  not  be  more  than  20  or  25 


656  MILITARY    HYGIENE. 

yards  from  the  tents  and  may  be  placed  wherever  desired  without 
regard  to  the  water-supply,  character  of  soil  or  depth  of  ground 
water.  The  general  rule  governing  the  location  of  latrines,  that 
they  should  be  as  far  as  possible  from  the  kitchen,  is  not  as  inflexible 
with  this  system  as  in  the  case  of  pit  latrines..  From  the  moment 
the  excreta  reach  the  trough  they  cease  to  be  dangerous.  Flies  are 
less  attracted  than  by  open  sinks  and,  if  lids  are  used,  can  be 
entirely  excluded.  The  floor,  kept  dry  and  hard,  is  much  less 
likely  to  become  polluted,  while  toilet  paper  does  not  readily 
escape  from  the  trough.  On  the  other  hand,  this  system  requires 
a  heavy  and  costly  material  and  is  only  applicable  to  cantonments 
and  permanent  camps.  It  would  also  be  useless  in  very  cold 
weather  with  the  temperature  below  freezing-point.  Water  and 
plenty  of  lime  or  oil  are  necessary.  Furthermore,  after  the  trough 
has  been  emptied  by  the  excavator,  there  still  remains  the  question 
of  final  disposal  which  may  be  a  troublesome  one.  It  sometimes 
happens  that  this  very  heavy  vehicle  becomes  useless  in  sandy 
or  miry  roads. 

Everything  considered,  it  is  now  the  general  opinion  that 
wherever  the  trough  latrine  can  be  used,  incinerators  will  be  found 
equally  practicable  and  more  efficient. 

EARTH-CLOSET    LATRINE. 

In  camps  where  the  trough  latrine  is  not  applicable  or  available, 
the  earth-closet  latrine  has  been  provided.  It  consists  of  the  same 
building,  row  of  seats  and  urinal,  but,  instead  of  a  trough,  there  is 
under  each  seat  a  galvanized  steel  box^  18  inches  wide,  14  inches 
deep,  21  inches  long  from  front  to  back  at  top  and  18  inches  at  bot- 
tom, the  rear  end  being  vertical  and  the  bottom  corners  rounded. 
Each  box  slides  out  through  a  corresponding  door  upon  a  platform 
of  joists  extending  2  feet  in  rear  of  the  wall.  The  contents  of  the 
boxes  are  disinfected  with  earth  or  lime.  If  lime  is  available,  the 
boxes,  before  being  used,  are  filled  about  one-fourth  of  their  depth 
with  milk  of  lime.  The  addition  of  a  small  quantity  of  crude  car- 
bolic acid  forms  a  very  effective  disinfecting  mixture.  The  boxes 
are  taken  out  as  often  as  necessary,  emptied,  washed  and  replaced. 
In  cold  countries  or  wherever  there  is  danger  of  freezing,  dry 
earth  or  lime  is  used. 

The   earth    used    should   be    the    sweepings    of   roads,    properly 


LATRINES. 


657 


screened,  or  the  top  soil,  sun-dried  and  pulverized.  If  kiln-dried, 
the  nitrifying  bacteria  upon  which  its  action  depends  would  be 
destroyed.  Sand,  ashes  and  sawdust  are  more  or  less  sterile  and 
should  only  be  used  when  nothing  better  is  at  hand. 

Figs.  218  and  219  show  an  earth-closet  latrine  as  above  described, 
but  on  the  knock-down  system,  that  is,  consisting  of  separable 
sections  of  siding,  floor  and  roof.  Instead  of  one  urinal  8  feet 
long,  there  is  one  4  feet  8  inches  long  at  each  end  of  the  seats,  a 
more  suitable  arrangement. 


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FIG.  218. —  Ground  plan  of  earth-closet  latrine.    Knock-down  system. 


FIG.  219. —  Cross  section  of  Fig.  218. 


CHAPTER  LIII. 
DISPOSAL  OF  EXCRETA  BY  INCINERATION. 

The  ideal  system  of  disposal  is  by  incineration,  that  is,  the  destruc- 
tion by  fire  of  all  excreta  in  the  very  pans  in  which  they  are  re- 
ceived. With  this  system  no  water  or  disinfectant  is  required,  and 
as  the  residuum  of  combustion  is  a  negligible  quantity  no  further  or 
final  disposal  need  be  provided  for.  It  is  also  applicable  to  any 
climate  and  extreme  of  weather. 

This  system,  at  one  time  highly  praised  and  extensively  used,  is 
not  now  often  seen  in  our  camps.  Its  cost,  difficulty  of  transporta- 
tion and  operation,  and  the  amount  of  fuel  required  are  serious 
objections  which  are  often  found  to  overbalance  its  advantages. 

Of  the  several  types  of  incinerators  tested  in  our  camps,  the 
following  appear  to  possess,  in  a  higher  degree,  the  qualities  which 
best  adapt  them  to  military  requirements. 

THE  McCALL  INCINERATOR.  —  This  is  the  first  type  of  excreta 
incinerator  used  in  our  Army  and  has  rendered  invaluable  services 
in  trying  situations.  (Figs.  220-222.)  It  is  installed  in  a  knock- 
down building  22  feet  6  inches  long  in  front  and  15  feet  wide.  It 
comprises  two  sections  at  right  angle  to  each  other.  Each  section 
consists  of  a  combustion  chamber  in  a  pit  24  inches  deep,  lined  with 
brick  (2),  and  of  a  steel  box  placed  over  the  pit.  In  the  combustion 
chamber  are  the  two  incinerator  pans  (25)  in  which  the  fecal  matter 
is  received.  In  the  steel  box,  forming  the  top  of  the  combustion 
chamber,  are  two  hinged,  wide  plates  (10)  and  three  narrow,  fixed 
plates  (9).  Each  box  is  covered  with  a  wooden  lid  or  seat  (13)  in 
which  4  holes  are  cut,  with  covers  closing  automatically.  Within  the 
angle  formed  by  the  intersection  of  the  two  pits  is  a  brick  flue  com- 
mon to  both.  Upon  this  rests  the  smokestack  base  and  upon  the 
latter  is  placed  the  vertical  smokestack  (20).  In  the  flue  a  grate  is 
mounted  (21),  forming  a  second  or  auxiliary  combustion  chamber 
(18).  A  urinal  (22),  with  hinged  lid,  corresponds  to  each  section. 
From  it  a  pipe  (n),  with  valve  (26),  conveys  the  urine  into  the  pan. 
The  valve  is  only  opened  when  the  pans  are  fired.  Another  pipe 
(221)  connects  the  urinal  with  the  smokestack  for  ventilation. 

658 


DISPOSAL    OF    EXCRETA    BY    INCINERATION. 


659 


For  use,  the  two  plates  (10)  are  lifted  up  and  the  wooden  seat  is 
placed  over  the  steel  box.  When  the  pans  are  full,  the  seat  is  re- 
moved and  a  fire  of  coke  or  coal  made  in  the  grate  (21)  ;  the  plates 
(10)  are  then  lowered,  thus  forming  a  tight  cover  for  the  combus- 
tion chamber,  and  the  pans  are  incinerated  by  burning  wood  in  the 
pit  underneath.  This  fire,  however,  is  not  to  be  started  until  the 
coke  in  the  grate  is  thoroughly  ignited  and  the  auxiliary  combustion 
chamber  strongly  heated ;  in  this  wray  all  obnoxious  gases  are  com- 
pletely destroyed  before  they  can  escape  from  the  smokestack. 


FIG.  220. —  Perspective  view  of  the  two  sections  of  the  McCall  incinerator. 

After  the  solid  matter  in  the  pans  is  incinerated,  the  valve  under  the 
urinal  is  opened  and  the  urine  gradually  discharged  into  the  pan  and 
evaporated.  From  3  to  5  hours,  according  to  size  and  quality  of  the 
fuel,  are  necessary  to  complete  the  incineration  of  excreta  in  one  pit. 
Dry,  hard  wood,  4  feet  long,  is  generally  used  as  fuel.  Each  section 
is  burned  out  once  a  day,  or  once  every  other  day  according  to  the 
strength  of  the  company,  the  most  convenient  time  being  in  the 
evening  or  at  night,  so  that  both  sections  may  always  be  available 
during  the  morning  hours. 


66o 


MILITARY    HYGIENE. 


It  is  evident  that  the  McCall  incinerator,  as  above  described,  is 
only  available  in  camps  of  some  permanency.  In  order  to  dispense 
with  the  brick  work  which  requires  heavy  material,  skilled  labor  and 
time,  and  that  it  may  be  set  up,  ready  for.  use,  as  soon  as  possible, 
after  reaching  camp,  the  inventor,  (in  his  191 1  model,  has  replaced 
the  brick  pit  by  a  steel  fire-box  lined  with  asbestos  boards.  (Fig. 
222.)  There  is  also-  an  independent  opening  into  the  coke  grate  to 
stoke  the  fire  without  interfering  with  the  main  combustion  cham- 
ber, and  the  urinals  have  been  slightly  modified  so  as  to  prevent 
dripping.  Thus-  improved  this  incinerator,  complete,  weighs  about 


FIG.  221. —  Longitudinal  sectional  elevation  of  the  McCall  incinerator. 

i, 800  pounds;  it  can  be  knocked  down  in  conveniently  handled 
pieces,  easily  transported,  and  set  up,  ready  for  use,  within  half  an 
hour  after  reaching  carnp.  For  permanent  camps,  however,  the 
brick  pit  is  still  considered  preferable. 

A  garbage  crematory  constructed  on  the  same  plan  is  also  in  use. 

The  Jones  Incinerator.  —  Capt.  Percy  L.  Jones,  Medical  Corps, 
drawing  his  inspiration  from  the  McCall  apparatus,  has  shown  how 
an  incinerator  can  be  extemporized  almost  anywhere.  A  hole  is  dug 
in  a  side-hill,  2l/2  feet  deep,  2  feet  wide  and  4^2  feet  long,  with  back 


DISPOSAL   OF    EXCRETA    BY    INCINERATION. 


66l 


and  floor  of  brick  or  stone  laid  without  mortar.  If  the  soil  has  suf- 
ficient consistency  or  if  the  camp  is  only  for  a  day  or  two  this  lining 
of  stone  is  not  necessary.  It  is  best,  however,  not  to  dispense  with 
the  stone  floor,  always  very  useful  for  the  evaporation  of  urine. 
One  foot  below  the  top,  the  sides  have  projecting  shoulders  upon 
which  rest  two  of  the  McCall  excreta  pans.  Over  all  is  the  boxed 
seat  with  4  holes ;  this  can  be  hinged  for  convenience  of  transporta- 
tion. Brush  or  canvas  screens  may  be  placed  around  so  as  to  make 
the  pit  fly-proof.  This  incinerator  is  likely  to  produce  unpleasant 


FIG.  222.—  McCall  Incinerator,  Improved   1911    Model,   Xo.  8  (portable). 

odors  when  fired  and  should  therefore  be  placed  to  the  leeward  of 
the  camp.  A  detached  can  should  be  kept  near  by  to  be  used  as 
urinal,  and  occasionally  emptied  upon  the  heated  stones.  If  this 
incinerator  is  only  for  one  night,  the  iron  pans  can  be  dispensed 
with  and  replaced  by  wooden  pans  or  boards  which  are  consumed 
with  the  excreta. 

THE  HARRIS  INCINERATOR.  —  This  incinerator  (model  1911)  con- 
sists essentially  of  a  rectangular  box  and  smoke  stack.  (Fig.  223.) 
The  box  is  7  feet  3  inches  long,  21  inches  high,  36  inches  wide,  and 
provides  8  seats.  The  entire  outfit  weighs  1,000  pounds.  It  is 


662 


MILITARY    HYGIENE. 


assembled  in  one  piece,  without  other  detachable  parts  than  the  stack, 
seats  and  covers,  and  rests  directly  upon  the  ground.  The  fire  cham- 
ber extends  the  entire  length  of  the  box,  the  flame  passing  from  it 
by  means  of  a  hood  or  flue  (forming  a  projection  in  rear  end)  and 
returning  over  the  excreta  on  the  floor  to  the  stack.  The  excreta 
fall  directly  on  a  slightly  convex  floor  which  is  nothing  but  the  roof 
of  the  fire  chamber ;  it  is  depressed  on  each  side  into  a  gutter  covered 
with  a  perforated  guard;  into  this  gutter  the  liquids  drain.  The 
urinal  consists  of  a  trough  3  feet  long  and  extending  8  inches  from 
the  rear  end  of  the  box.  The  cover  is  raised  for  urination,  the 
stream  splashing  against  it,  and  closes  automatically.  The  trough 
drains  continuously  into  the  gutters  of  the  floor  and  is  sterilized  by 
the  heat  of  each  burning.  From  the  above  arrangement  it  is  seen 
that  the  evaporation  of  urine  and  combustion  of  the  solid  excreta 
are  simultaneous. 

This  incinerator  has  a  capacity  of  15  men  per  seat.     It  is  usually 


FIG.  223. —  The  Harris  incinerator.     Model  1911. 


DISPOSAL   OF   EXCRETA    BY    INCINERATION.  663 

burned  once  a  day  and  requires  only  1/20  of  a  cord  of  wood  for 
each  complete  disposal  of  solids  and  liquids.  Although  without 
secondary  combustion  chamber,  it  is  claimed  that  all  offensive  odors 
are  as  thoroughly  consumed  as  in  types  of  incinerators  provided 
with  it. 

It  has  been  very  favorably  commented  on  by  official  boards,  espe- 
cially for  (i)  its  simplicity  of  construction  and  ease  of  operation, 
(2)  its  small  weight  and  bulk,  being  lighter  than  any  other  incin- 
erator with  equal  number  of  seats,  (3)  its  economy  of  fuel,  requir- 
ing less  than  any  other  type,  and  (4)  its  general  efficiency. 

A  garbage  crematory  has  also  been  constructed  on  the  same  prin- 
ciples. 

THE  Q.  M.  C.  INCINERATOR  No.  i,  MODEL  1911.  —  This  excellent 
incinerator,  devised  by  the  Q.  M.  Corps,  is  4  feet  long,  30^2  inches 
wide  and  26  inches  high.  (Fig.  224.)  It  is  fitted  with  4  seats,  2 
on  each  side,  and  weighs  complete  about  1,000  pounds.  The  shell 
itself,  without  linings  or  trimmings,  weighs  310  pounds.  The  top 
consists  of  4  cast-iron  panels,  each  with  an  oval  opening  in  center 
closed  with  cast-iron  lid.  Over  these  are  fitted  4  wooden  seats, 
their  holes  corresponding  to  the  openings  in  the  cast-iron  panels,  and 
covered  with  perforated  lids,  the  perforations  screened  with  wire 
gauze.  Inside  are  found,  from  above  downward,  segmented  grate, 
drip  pan  and  charcoal  basket-burner.  The  pan  is  46^/2  inches  long, 
25  inches  wide  and  2^  inches  deep.  The  basket-burner  is  6  inches 
deep,  and  has  perforated  sides,  ends  and  bottom  for  draft.  A 
urinal,  with  self-closing  lid,  is  attached  on  each  side  of  the  smoke 
pipe  without  screw  or  bolt,  and  a  galvanized  pipe  conveys  the  urine 
to  the  drip  pan.  Another  pipe  runs  from  the  top  edge  to  the  smoke 
pipe,  as  vent. 

To  operate  this  incinerator,  it  is  set  on  the  ground,  having  no 
bottom.  The  cast-iron  panels,  without  lids,  are  covered  with  the 
wooden  seats.  The  large  drip  pan  is  slid  in  on  lugs;  being  just 
under  the  heavy  cast-iron  grate  bars  it  catches  the  urine  and  such 
fecal  matter  as  passes  through  the  bars.  If  pulled  to  the  front  as 
far  as  possible,  the  odors  will  escape  freely  to  the  smoke  pipe.  All 
drafts  should  be  closed  so  that  there  will  be  a  downward  suction 
through  the  screened  perforations  in  the  lids,  thus  preventing  heat 
and  odors  from  escaping.  When  the  pan  is  in  position,  the  burner, 
in  which  a  charcoal  or  coke  fire  has  been  started,  is  placed  under  it 


664 


MILITARY    HYGIENE. 


and  furnishes  ample  heat  to  evaporate  the  urine  discharged  in  the 
pan.  This  heat  should  be  so  maintained  as  never  to  make  it  uncom- 
fortable for  the  men  using  the  seats. 

At  night,  or  whenever  desired,  the  wooden  seats,  drip  pan  and 
basket-burner  are  removed,  the  lids  placed  in  the  cast-iron  panels, 


FIG.  224. —  The  Q.  M.  C.  incinerator,  No.  i,  Model   1911.     Showing  urinals, 
cast-iron  lid,  wooden  seat  and  charcoal  burner. 

and  a  wood  fire  made  under  the  grate  bars.  All  excreta  are  thus 
thoroughly  incinerated.  Should  the  pan  contain  matters  needing 
incineration  it  can  be  left  in  until  this  is  accomplished. 

This  incinerator  can  also  be  used  as  garbage  crematory  by  remov- 


DISPOSAL   OF   EXCRETA    BY    INCINERATION.  665 

ing  any  one  of  the  cast-iron  panels  to  dump  the  garbage  on  the 
grates,  taking  care  that  the  liquid  slops  do  not  overflow  the  pan. 

The  Conley  incinerator,  as  well  as  the  Lewis  and  Kitchin  incin- 
erator, have  also  been  tried  in  some  of  our  camps  with  more  or  less 
success,  but  have  long  since  been  discarded. 

Remarks.  —  The  incinerators  described  are  also  capable  of  dis- 
posing of  a  large  proportion  of  the  garbage  of  the  camp,  and  there 
has  been  a  tendency  to  develop  them  in  that  direction,  tha.t  is  to  say, 
make  them  burn  up  garbage  and  liquid-wastes  as  well  as  excreta. 

It  is  quite  doubtful,  however,  whether  such  combination  is  desir- 
able and  yields  the  best  results.  The  incinerator  sheds,  necessarily 
visited  by  all  the  men  and  always  kept  scrupulously  clean,  should 
not  also  become  garbage  pens.  Excreta  and  garbage  require  some- 
what different  treatment  and  can  be  more  conveniently  disposed  of 
separately.  It  is  not  believed  that  such  separation  would  require 
more  material  or  the  expenditure  of  much  more  fuel,  for  appliances 
constructed  for  one  special  object  can  accomplish  it  more  perfectly 
and  economically  than  if  designed  for  several  purposes.  It  is  also 
to  be  borne  in  mind  that  there  are  camp  sites  where  only  kitchen 
incinerators  are  required,  the  excreta  being  already  provided  for  by 
sewerage;  or  vice  versa,  where  kitchen  incinerators  already  exist 
and  only  excreta  incinerators  are  needed. 

Ambulant  Incinerators.  —  A  system  of  ambulant  incinerators 
that  could  follow  moving  troops  and  always  be  available  as  soon  as 
camp  was  reached  would  be  ideally  perfect,  but  is  obviously  im- 
practicable:  from  150  to  200  such  incinerators,  including  600  to  Soo 
mules,  would  be  required  for  a  division,  an  enormous  addition  to 
the  train  which  would  seriously  hamper  the  mobility  of  the  com- 
mand. Furthermore,  as  they  could  seldom  find  their  respective  or- 
ganizations at  the  end  of  a  march,  until  much  too  late  to  prevent 
the  contamination  of  the  camp,  they  would  fail  of  their  purpose. 
There  are  doubtless  circumstances  when  they  might  be  serviceable, 
for  instance  in  connection  with  summer  camps  where  they  would 
enable  organizations  to  change  sites  readily  and  safely,  or  for  small 
commands  marching  over  good  roads. 


CHAPTER  LIV. 
LAVATORY. 

DISPOSAL   OF   WASTES,    GARBAGE,   REFUSE   AND   MANURE   IN 

CAMP. 

Conveniences  for  washing  body  and  clothing  must  be  provided 
as  soon  as  practicable,  especially  water  barrels  or  cans,,  wash  tubs 
and  hand  basins.  If  the  camp  is  to  last  more  than  a  day  or  two, 
a  place  should  be  set  apart  in  each  company,  not  too  near  the  kitchen, 
as  a  lavatory.  It  is  not  desirable  to  have  the  washing  of  linen  and 
clothing  done  on  the  company  grounds.  One  laundry  shed  for  each 
battalion  is  sufficient  and  this  may  be  located  where  most  con- 
venient with  respect  to  the  water-supply.  Waste  waters  from  lava- 
tory and  laundry  should  not  be  allowed  to  run  on  the  ground  and 
soak  into  it;  they  are  not  only  unsightly  and  ill-smelling,  but  the 
most  dangerous  of  all  liquid  wastes,  being  always  the  vehicle  of 
numerous  germs  (see  page  254).  They  should  be  emptied  into  suit- 
able receptacles  and  carted  to  the  rock-pile  crematory  or  any  special 
evaporator  or  incinerator  used  for  the  purpose.  They  may  also  be 
piped,  or  conveyed  by  a  disinfected  trench  to  a  water-course,  pit  or 
distant  gully. 

The  regulation  field  lavatory  for  one  company  consists  of  a  knock- 
down building  25  feet  long  in  front  and  8  feet  6  inches  wide,  con- 
taining 5  shower  baths  and  i  cast-iron  wash  sink  10  feet  long  (in 
2  sections),  enamelled  inside,  with  4  nickel-plated  compression 
faucets.  When  intended  for  the  use  of  a  battalion  it  is  extended 
in  length  so  as  to  accommodate  4  two-section  sinks  and  15  showers. 

This  lavatory  affords  no  facilities  for  the  washing  of  clothing  or 
linen  and  is  so  far  defective.  It  should  contain  4  wash  tubs,  or  else 
provision  should  be  made  for  a  battalion  or  regimental  laundry. 

A  simple  sanitary  arrangement  is  the  following:  Make  a  hard 
and  impermeable  floor,  if  not  naturally  so,  in  the  manner  described 
for  tents  (page  615).  This  floor  should  preferably  have  a  slight 
slope.  Upon  it  place  a  wooden  grating,  and  provide  benches  for 
basins  as  well  as  for  washing  clothes.  On  the  lower  side,  a  trench 
four  inches  deep  and  a  foot  wide  is  dug  and  filled  with  stones,  lead' 

666 


DISPOSAL    OF   WASTES    IN    CAMP.  667 

ing  to  a  soakage  pit  filled  with  stones,  rs  for  urine  disposal  (see 
page  652). 

Another  arrangement,  sometimes  seen  in  our  camps,  consists  of 
two  wide  boards  set  on  trestles,  10  inches  apart  and  slightly  slant- 
ing towards  each  other  so  that  the  water  may  drip  down  the  space 
between  them.  The  trench  should  be  directly  below  this  space  and 
have  a  sufficient  gradient  to  insure  good  drainage. 

The  proper  treatment  of  garbage  in  any  place  is  facilitated  by 
the  separation  of  solids  and  liquids.  This  is  readily  accomplished 
in  camp  by  means  of  a  boxed  screen  placed  in  the  mouth  of  the 
barrel  intended  for  liquid  slops,  and  only  allowing  liquids  to  drain 
through.  This  screen  should  have  a  projecting  rim  or  flange  so 
as  to  be  supported  by  the  edges  of  the  barrel  and  easily  removed. 

All  solid  garbage  should  be  burned;  no  other  disposition  is  to  be 
considered  whenever  fuel  is  available.  Destruction  by  fire  gives 
absolute  security.  A  garbage  pit  is  highly  objectionable  and  to  be 
tolerated  only  when  incineration  is  impossible.  In  such  case  it 
should  be  fired  daily  with  crude  petroleum,  like  the  latrines. 
Weather  permitting,  solid  garbage  may  also  be  spread  on  the  ground 
to  dry,  then  mixed  up  with  inflammable  refuse,  like  horse  manure, 
and  burned.  For  a  few  days  there  is  no  objection  to  its  being 
thrown  in  latrine  pits. 

Kitchen  Pit.  —  Liquid  wastes  from  the  company  kitchen  are  best 
disposed  of  as  described  under  Company  Incinerator.  If  no  method 
of  incineration  is  available,  a  pit,  dug  near  the  kitchen  fire,  may  be 
used  as  provided  in  the  Field  Regulations.  A  convenient  size  for 
it  is  about  four  feet  in  length  and  depth,  but  not  over  three  in  width, 
so  that  it  may  be  easily  roofed  over  with  cross  sticks,  grass  and 
earth.  At  the  end  nearest  the  kitchen  should  be  a  boxed  opening, 
preferably  funnel-shaped,  with  screened  bottom,  into  which  all  liquid 
wastes  are  thrown,  the  screen  retaining-  all  particles  of  solid  garbage. 
When  not  in  use,  the  opening  should  be  kept  covered  with  a  lid  to 
prevent  odors  and  exclude  flies.  A  ventilating  shaft  or  pipe  may 
be  placed  at  the  other  end,  but  is  not  essential.  The  contents  will 
usually  seep  into  the  subsoil  and  seldom  overflow;  if  necessary  they 
can  be  pumped  out  by  the  excavator  wagon. 

This  kitchen  pit  when  properly  constructed,  in  porous  soil,  is  gen- 
erally satisfactory;  but  as  it  is  liable  to  generate  offensive  smells 
it  is  better  to  dispense  with  it  whenever  a  better  method  is  available. 


668  MILITARY    HYGIENE. 

A  more  satisfactory  means  of  disposal,  in  porous  ground,  is  an  or- 
dinary hole,  8  or  9  inches  in  diameter,  such  as  is  readily  dug  with 
a  post-hole  auger. 

One  or  two  barrels,  or  galvanized-iron  cans,  with  lids,  should  be 
supplied  each  company  for  its  dry  garbage,  if  not  burned  in  the 
kitchen  fire,  and  an  additional  one  for  liquid  wastes  if  a  pit  is  not 
used.  The  iron  can  which  serves  as  night  urinal  is  kept  near  the 
latrine  and  utilized  to  collect  dry  refuse  during  the  day.  Two  more 
cans  may  be  necessary  for  the  lavatory  and  laundry  wastes  if  these 
are  not  disposed  of  in  some  other  way. 

Sanitary  Cart.  —  A  special  sanitary  iron  cart  is  sometimes  sup- 
plied by  the  Q.  M.  Corps  for  the  removal  of  garbage,  liquid  and 
solid.  But  it  is  difficult  to  empty  slop  barrels  into  such  a  cart 
without  spilling,  while  leakage  is  also  liable  to  occur  as  it  jolts  on 
the  way,  so  that  the  vicinity  of  kitchens  as  well  as  company  streets 
and  camp  roads  are  exposed  to  fouling  from  these  causes.  It  would 
be  much  better  to  use  it  exclusively  for  dry  or  nearly  dry  garbage, 
and  to  remove  all  liquid  wastes  by  the  usual  excavator  wagon. 

COMPANY  OR  KITCHEN  INCINERATOR.  —  The  company  kitchen  fire, 
if  properly  prepared  and  managed,  can  be  made  to  burn  much  of  the 
garbage,  liquid  and  solid,  utilizing  the  latter  as  fuel.  The  advice 
given  in  the  "  Manual  for  Army  Cooks  "  is  excellent :  4'  Burn  every- 
thing [in  camp  kitchen  fire]  — coffee  grounds,  parings,  bones,  meat 
wastes;  even  old  tin  cans,  for  if  thrown  out  anywhere,  even  buried, 
they  attract  flies ;  tin  cans  are  fly  traps ;  burned  and  cleaned  out  by 
fire  daily  they  are  harmless.  Fires  should  be  cleaned  of  burnt 
refuse  once  a  day." 

With  an  ordinary  open  kitchen  fire  it  is  quite  practicable  thus  to 
dispose  of  much  of  the  company  garbage,  but  when  the  fireplace  is 
constructed  with  a  view  to  its  efficiency  as  garbage  incinerator,  cook- 
ing over  it  becomes  more  difficult  and  requires  special  fixtures. 
The  fire  used  in  the  field  range  can  be  utilized  but  only  to  a  small 
extent  for  the  burning  of  wastes. 

The  company  incinerator  consists  essentially  of  a  pit  filled  in  with 
loose  stones,  as  first  recommended  by  H.  A.  Arnold,  N.  G.  Pa.  In 
its  construction,  care  should  be  taken  that  the  layer  of  rocks  lining 
the  floor  is  not  more  than  a  foot  deep,  inasmuch  as  this  is  about  the 
depth  to  which  the  heat  penetrates.  Liquids  gravitating  below  this 
level  are  liable  to  ferment  and  become  foul  when  the  ground  is  not 


DISPOSAL    OF    WASTES    IX    CAMP. 


669 


sufficiently  porous,  especially  should  the  fire  be  discontinued  for  a 
few  days  during  the  temporary  absence  of  the  company;  in  this 
case  the  pit  may  also  become  a  breeding  place  for  flies.  Economy 
of  time  and  material  demands  that  the  excavation  be  not  any  deeper 
than  necessary. 

The  type  finally  developed  at  the  maneuver  camps  of  San  An- 
tonio, Texas,  in  1911,  by  Major  P.  E.  Straub,  and  since  then  gen- 
erally used  (Fig.  225),  consists  of  a  bed  of  rocks,  level  with  the 
ground,  I  foot  deep,  3  feet  wide  and  4^  feet  long,  surrounded  by  a 
sloping  stone  wall,  18  inches  high,  except  at  one  end  which  is  left 
open  for  draft,  fuel  and  access  to  the  fire.  The  stone  wall  absorbs 
much  of  the  heat  which  would  otherwise  be  dissipated  into  space, 
and  increases  enormously  the  evaporating  capacity  of  the  incinerator. 


FIG.  225. —  The  Straub  garbage  incinerator.     Model  1911. 


6/O  MILITARY    HYGIENE. 

Large  stones  (cocoa-nut  size)  are  much  better  than  small  ones ;  as 
to  composition,  any  kind  will  do,  but  limestone  which  disintegrates 
and  flint  which  explodes  are  not  as  good  as  sandstone.  During  a 
rainy  season  it  would  be  advantageous  to  raise  the  rock  bed  a  few 
inches  above  the  ground  and  bank  it  around  with  earth  to  prevent 
flooding. 

Straitb  found  that,  with  ordinary  care  and  attention,  about  1/6  of 
a  cord  of  wood  per  day  per  company  was  more  than  sufficient  for 
the  destruction  of  all  slops  and  garbage.  Careful  experimentation 
showed  that  by  using  this  amount  of  wood,  a  skilled  attendant  could 
destroy  100  gallons  of  liquids  and  23  cubic  feet  of  solid  garbage  in 
about  12  hours.  The  liquid  slops  are  evaporated  by  being  poured 
slowly  along  the  sloping  walls  of  the  incinerator,  frequently  but  only 
a  few  dipperfuls  at  a  time,  while  the  solid  garbage  is  placed  over  the 
firebed,  on  top  of  the  fuel.  When  the  liquids  are  excessive  it  may 
be  expedient  to  partly  evaporate  them  in  a  tin  boiler.  Tin  cans  and 
other  incombustible  material  are  raked  out  as  often  as  necessary.  It 
is  a  good  plan  to  remove  the  stones  making  up  the  floor  about  once 
a  week  so  as  to  clear  the  pit  of  ashes  and  deibris.  Cooking  on  such 
a  rock-lined  pit  is  made  relatively  easy  by  means  of  a  long-legged 
spider,  such  as  used  by  the  militia  of  several  States.  Where  field 
cooking  ranges  are  used  and  the  companies  are  small,  it  will  often 
be  sufficient  to  operate  one  incinerator  for  each  battalion. 

The  Straub  model  is  often  simplified  without  much  loss  of 
efficiency.  Thus,  when  stones  are  scarce,  the  banks  of  the  pit  can 
be  built  up  of  the  excavated  earth,  well  packed  and  tamped,  with- 
out stones.  Where  the  incinerator  is  only  to  foe  used  for  a  few 
days  and  the  soil  is  porous,  the  depth  of  the  stone  bed  may  be 
reduced  to  8  or  6  inches. 

Even  when  stones  are  lacking,  a  fire  made  in  the  same  manner 
between  two  walls  of  earth,  in  a  shallow  pit,  will  generally  be 
capable  of  disposing  of  much  of  the  company  garbage,  solid  and 
liquid.  In  such  case  it  is  well  to  fill  the  bottom  of  the  pit  with  tin 
cans,  if  at  hand,  as  a  substitute  for  stones. 

Some  experience  is  required  before  troops  can  successfully  ope- 
rate the  kitchen  incinerator,  and  sanitary  inspectors  will  often  need 
patient  persistency  to  convince  officers  and  men  that  this  method  of 
disposing  of  kitchen  and  company  wastes  in  the  field  is  the  most 
practical,  economical  and  efficient. 


DISPOSAL    OF    WASTES    IN    CAMP. 


671 


The  Guthrie  incinerator  (Fig.  226),  adopted  by  the  Qmr.  Corps, 
consists  essentially  of  a  fire  chamber  and  an  evaporating  pan.  Its 
walls  are  of  brick  or  stone,  and  a  draft  is  provided  by  a  Sibley  stove 
and  pipe.  It  is  very  effective  for  solid  and  liquid  wastes,  but  requires 
special  material  not  always  on  hand.  Unless  the  evaporating  pan 
is  thoroughly  scraped  and  cleaned  daily  a  thick  crust  forms  on  the 
bottom,  resulting  in  an  increased  consumption  of  fuel  and  in  the 
destruction  of  the  pan.  An  overflow  hole  in  the  end  of  the  pan  is 
recommended  to  prevent  its  contents  from  boiling  over  and  pol- 
luting the  surrounding  grounds. 


LONGITUDINAL  .SECTION 

FIG.  226. —  Guthrie  incinerator.    Quartermaster  Corps  model. 


672  MILITARY    HYGIENE. 

CALDWELL  (or  ENGLISH)  INCINERATOR.  —  Whenever  fuel  is  scarce 
and  stones  few,  probably  no  device  for  the  destruction  of  garbage 
and  refuse  is  more  readily  improvised  and  efficient  than  this  type  of 
incinerator.  It  consists  of  a  trench  10  feet  long  and  i  foot  wide, 
about  15  inches  deep  at  the  middle  and  thence  gradually  shallowing 
up  at  each  end  to  the  surface  level.  Over  the  deep  part  a  barrel  is 
placed  and,  around  it,  is  constructed  a  chimney  5  feet  high,  of  clay, 
earth  or  sod,  sprinkled  with  water  and  packed  tightly.  A  fire  is 
made  in  the  interior  and  the  barrel  burned  out,  after  which  there 
remains  a  solid  cone  of  earth.  Fuel  and  garbage  are  dropped  down 
the  chimney.  Of  the  two  openings,  the  one  to  leeward  is  closed. 
A  bed  of  tin  cans  in  the  fireplace,  through  which  the  air  passes  freely, 
is  a  fair  substitute  for  a  grate.  Every  morning,  or  as  often  as 
necessary,  the  ashes  and  cans  are  raked  out  and  a  fresh  fire  started 
on  a  new  bed  of  cans.  If  the  soil  is  porous,  a  large  quantity  of 
liquids  can  be  evaporated  by  pouring  them  slowly  into  the  trench. 

This  incinerator  will  burn  the  solid  garbage  and  refuse  of  a  bat- 
talion. With  proper  material  and  more  skilled  labor  it  can  be  ex- 
tended and  perfected  so  as  to  easily  meet  the  needs  of  a  regiment. 
Thus,  instead  of  one  trench,  two  trenches  may  be  dug,  bisecting  each 
other  at  right  angle.  The  chimney  is  built  over  the  point  of  inter- 
section ;  it  should  have  an  inside  diameter  of  3  or  4  feet  at  the  base, 
a  little  less  at  the  top,  and  a  height  of  at  least  6  feet ;  across  the 
trenches,  boards,  flat  stones  or  pieces  of  sheet  iron  are  required  for 
its  support.  If  iron  bars  are  available  they  can  be  placed  in  so  as  to 
form  a  grate.  The  great  advantage  of  a  four-opening  incinerator  is 
that  one  of  the  trenches  is  always  in  the  direction  of  the  wind,  and 
a  good  draft  can  always  be  secured  by  plugging  the  throats  of  the 
other  trenches. 

If  a  few  pieces  of  corrugated  roof -iron  are  at  hand  they  can  be 
easily  shaped  into  a  serviceable  chimney,  thus  saving  time  and  labor. 
Sometimes  it  is  practicable  to  erect  a  more  permanent  structure  of 
stone  and  brick.  Rubble  stones  plastered  with  mud  will  make  a 
very  satisfactory  chimney. 

ROCK-PILE  CREMATORY.  —  For  the  general  use  of  a  regimental 
or  brigade  camp  where  fuel  and  stones  are  plentiful,  and  in  the 
a'bsence  of  special  appliances,  there  is  nothing  better  than  this  type 
of  crematory  for  the  incineration  of  garbage  and  refuse,  solid  and 
liquid.  (Fig.  227.)  It  is  thus  described  in  specifications  from  the 
office  of  the  chief  Q.  M.  Corps,  January,  1908: 


DISPOSAL    OF    WASTES    IN    CAMP. 


673 


"At  some  convenient  location  selected  by  the  military  authorities 
a  circular  pit  is  dug,  three  feet  in  depth  and  fifteen  feet  in  diameter, 
the  bottom  to  be  covered  with  loose  stones  to  the  depth  of  fourteen 
or  sixteen  inches.  On  this  is  built  a  circular  wall  to  the  height  of 
one  foot  above  the  original  ground  line,  and  the  excavated  earth  is 
packed  against  it  clear  to  the  top  so  as  to  provide  a  sloping  approach 
and  thereby  prevent  surface  water  gaining  access  to  the  pit.  A 
pyramid  of  large  stones,  four  or  five  feet  high,  occupies  the  center. 
This  feature  is  essential  to  provide  central  draft  and  steady  fire. 

"  The  bottom  stones  receive  the  liquid  portions  of  the  garbage 
without  affecting  the  fire,  and  soon  evaporate  and  dissipate  them. 
The  solid  portions  are  soon  desiccated  and  become  fuel.  Care 
should  be  exercised  to  empty  the  garbage  into. and  not  around  the 
crematory." 

Where  the  supply  of  stones  is  scant,  tin  cans  may  be  substituted 
to  a  certain  extent,  and  used  repeatedly. 

It  is  desirable  to  place  a  few  heavy  stones  along  the  edge  of  the 
pit  to  serve  as  bumpers  or  guard  to  the  rear  wheels  of  the  cart  or 
excavator. 

This  crematory  has  been  used  repeatedly  in  our  camps  and  given 
general  satisfaction.  Only  one  man  is  required  for  its  service.  At 
camp  Captain  John  Smith,  Jamestown  Exposition,  it  was  found  that 
one  cord  of  wood  consumed  about  4,500  pounds  of  refuse  and  gar- 
bage, including  all  kitchen  wastes  and  slops.  It  will  likewise  incin- 
erate manure  and  dead  animals. 


FIG.  227. —  Rock  pile  crematory- 

The  above  crematory  has  been  superseded  by  a  more  recent  type 
(Fig.  228),  of  smaller  dimensions  and  simpler  construction,  shal- 
lower and  without  central  cone.  This  new  model  is  more  prac- 
tical, requires  fewer  stones  and  is  more  easily  cleaned  out. 


674 


MILITARY    HYGIENE. 


FIG.  228. —  Rock  pile  crematory.     New  model. 

The  present  tendency  in  our  camps,  strongly  approved  by  good 
hygiene,  is  not  only  to  burn  all  excreta  and  solid  garbage,  but  also 
to  dispose  of  all  liquid  wastes  by  evaporation  and  incineration  when- 
ever practicable.  Special  appliances  have  been  devised  for  the  pur- 
pose and,  as  stated  before,  efforts  made,  more  or  less  successfully, 
to  utilize  excreta  incinerators  to  the  same  end.  The  effect  of  the 
complete  burning  of  excreta  and  garbage  and  of  strict  ground  police 
was  strikingly  illustrated  in  our  latest  camps  of  instruction.  Even 
with  the  use  of  pit  latrines,  it  has  been  demonstrated  that  the  care- 
ful burning  of  all  garbage  and  refuse,  together  with  the  strict 
observance  of  all  other  sanitary  measures  tending  to  prevent  the 
breeding  of  flies  and  dissemination  of  infectious  germs,  will  gener- 
ally keep  the  ratio  of  sickness,  in  camps,  below  the  usual  garrison 
rates. 

Disposal  of  Manure.  —  Manure  breeds  flies,  renders  the  soil  a 
better  medium  for  the  growth  of  micro-organisms  and  is  otherwise 
objectionable.  Therefore  stable-sheds  and  picket-lines  must  receive 
special  attention.  They  should  preferably  be  located  on  porous, 
absorbent  soil  so  that  the  urine  may  quickly  disappear.  As  little 
hay  and  straw  should  be  allowed  to  litter  the  ground  as  possible 


DISPOSAL    OF    WASTES    IN    CAMP. 


675 


so  as  to  reduce  the  amount  of  manure  to  a  minimum.  If  the 
manure  is  not  utilized  by  farmers,  it  is  best  to  haul  it  away  and 
burn  it.  The  picket-lines  and  stable-sheds  should  be  carefully 
raked,  and  all  dung  scraped  up  and  cremated.  As  often  as  may 
be  desirable,  they  are  covered  with  a  thin  layer  of  clean  fresh  soil, 
sprinkled  with  lime,  or  burned  up  with  crude  petroleum. 

A  general  order  from  the  War  Department  directs  that : 

"All  manure  will  be  hauled  to  the  camp  dump.  Picket  lines  will 
be  kept  broom  swept,  and  all  manure  and  straw  hauled  off  daily. 
A  weekly  incineration  of  the  picket  lines  will  be  accomplished  with 
crude  oil  at  the  rate  of  10  gallons  to  each  line." 

A  simple  method  of  manure  disposal  consists  in  building  it  into  a 
stack  and  setting  fire  to  it ;  if  dry  and  containing  a  good  deal  of 
bedding,  such  stack  will  continue  burning  until  entirely  consumed. 

A  more  effective  method  is  the  so-called  "  Panama  plan  "  in  which 
the  manure  is  piled  on  a  grating  of  railroad  iron  raised  a  few  feet 
above  the  ground  and  surrounded  by  a  railing  (Fig  229).  The 
rails  forming  the  floor  should  be  laid  at  right  angle  to  the  long  axk 
of  the  incinerator,  and  it  is  an  advantage  to  have  them  parallel  to 
the  direction  of  the  prevailing  wind.  The  fly  larvae  are  quickly 
destroyed  so  that  fewer  escape  than  by  the  windrow  method.  No 
oil  or  other  fuel  is  used  except  during  wet  weather.  This  inciner- 
ator is  especially  adapted  to  cantonments  and  permanent  camps. 


FIG.  229. —  Burning  manure  on  grating  of  iron  rails. 


6/6  MILITARY    HYGIENE. 

For  most  camps  the  windrow  method,  as  recommended  by  Major 
R.  B.  Miller,  is  the  most  practical  and  efficient.  The  manure  is 
dumped  from  the  tail  of  the  wagons  in  narrow  windrows  about 
8  feet  apart.  After  drying  for  a  few  hours  each  windrow  is  spotted 
with  oil  at  intervals  of  six  feet  on  the  windward  side  and  fired. 
The  next  day  the  wagons  straddle  the  same  windrows  and  dump  the 
manure  on  the  hot,  smoldering  ashes  of  the  previous  day's  burning. 
In  order  to  prevent  injury  to  the  animals'  feet  it  is  necessary  to 
keep  the  windrows  raked  from  each  side  so  that  they  do  not  exceed 
two  and  one-half  feet  in  width.  Tin  cans,  fragments  of  bottles, 
etc.,  should  be  excluded  on  account  of  the  danger  to  the  animals' 
fczt.  Waste  paper  should  be  separately  burned  to  prevent  its  scat- 
tering by  the  wind.  When  the  manure  is  wet,  the  wagons  are 
required  to  drive  between  the  windrows  where  their  loads  are 
spread  in  a  thin  layer.  When  dry  the  manure  is  raked  into  the 
windrows  and  fired  as  usual. 

It  has  been  observed  that  a  fly  never  lays  its  eggs  in  a  dry  place, 
nor  will  the  eggs  hatch  without  moisture.  This  explains  why  the 
great  majority  of  the  eggs  are  deposited  on  the  manure  before  it 
leaves  the  picket  lines.  Therefore,  if  it  is  intended  to  destroy  all 
the  larvae,  the  manure  should  be  burned  as  soon  as  possible,  or  not 
later  than  10  days  after  its  removal  from  the  picket  lines. 


CHAPTER    LV. 
GENERAL  SANITARY  RULES  IN  THE  FIELD. 

Experience  has  shown  that  in  the  course  of  a  campaign,  while  on 
active  duty  involving  much  marching  and  fighting,  soldiers  are  sel- 
dom sick ;  that  scant  rations,  worn-out  clothing,  exposure  to  inclem- 
ent weather  and  hardships  are  seldom  predisposing  causes  of  infec- 
tious diseases;  that,  on  the  contrary,  hard  work  and  plain  fare  are 
good  preservatives  against  disease,  rendering  the  men  more  resistant 
to  germ  infection.  The  danger  comes  as  soon  as  soldiers  get  into 
permanent  or  semi-permanent  camps  and  begin  to  make  themselves 
comfortable,  that  is  to  say,  to  devote  much  of  their  time  to  eating, 
sleeping  and  diverting  themselves,  as  was  illustrated  at  Santiago  de 
Cuba,  in  1898,  after  the  surrender  of  the  enemy,  and  by  the  English 
during  the  Boer  War,  at  Bloemfontein  where,  after  an  exhausting 
campaign  quite  free  from  sickness,  they  encamped  to  rest  and 
recuperate. 

In  camps,  owing  to  the  large  aggregations  of  men  thrown  into 
close  contact,  the  liability  to  water  pollution,  the  imperfection  of 
sanitary  conveniences  and  difficulty  of  protecting  food  against  infec- 
tion, the  facilities  of  germ  transmission  are  very  much  increased, 
while  the  effects  of  such  transmission  are  momentous.  The  general 
indications,  therefore,  to  preserve  health  in  camp,  are :  avoidance  of 
crowding  and  unnecessary  concentrations,  care  in  eating  and  drink- 
ing, adequate  sanitary  measures  (including  personal  hygiene)  and 
active  exercise.  These  subjects  have  been  treated  in  their  proper 
chapters,  but  on  account  of  their  importance  may  now  again  be 
briefly  considered  in  their  bearing  upon  camp  life. 

i.  The  food  should  be  sufficient,  always  wholesome,  varied  and 
well  cooked.  As  already  dwelt  upon,  there  is  more  danger  to  be 
apprehended  from  excess  than  from  scarcity,  especially  when  the 
men  are  at  liberty  to  leave  the  camp  and  patronize  restaurants  not 
under  military  control.  The  sale  of  foods  and  drinks  in  camps  by 
peddlers  and  hucksters  should  be  strictly  prohibited,  or  at  least 
limited  to  authorized  exchanges,  under  the  supervision  of  the  regi- 
mental sanitary  officers.  During  the  prevalence  of  epidemics  of 
typhoid  fever,  cholera  or  dysentery  in  the  vicinity  of  camps,  it  is 

677 


678  MILITARY    HYGIENE. 

absolutely  necessary  not  only  that  the  men  be  prevented  from  eating 
or  drinking  beyond  camp  limits,  but  that  all  supplies  from  local 
markets  be  carefully  inspected  and  their  origin  inquired  into  before 
being  allowed  in. 

The  men  of  each  company  should  be  required  to  eat  in  the  mess- 
shelter  or  at  some  designated  point,  and  not  permitted  to  carry  their 
food  to  their  tents  or  eat  it  at  random  in  the  company  street,  as  this 
always  results  in  pollution  of  the  soil.  A  receptacle  should  be  pro- 
vided for  wastes  and  the  scrapings  of  the  kit  meat-can,  as  well  as  a 
pail  of  hot  water  from  which  to  wash  the  meat-cans,  knives  and 
forks. 

For  permanent  camps,  the  O.  M.  Corps  has  devised  a  field  kitchen 
and  mess-hall  combined,  54  feet  long,  20  feet  wide  and  roofed  with 
rubberoid  (Fig.  230).  These  dimensions  can  be  reduced  and  the 
building  covered  with  one  or  two  paulins. 

2.  Every  effort  must  be  made  to  prevent  contamination  of  the 
water-supply.  As  soon  as  there  is  a  reasonable  doubt  of  its  purity 
it  must  be  sterilized  or  filtered.  A  company  will  require  two  barrels 
of  water  daily  for  drinking  purposes.  The  necessary  appliances  and 
vessels  for  boiling  or  filtering  having  been  provided,  a  man  should 
be  specially  detailed  to  attend  to  the  supply  of  the  company.  The 
Forbes  sterilizer,  Darnall  filter  and  sterilizing  water  bag  being 
easily  transportable,  there  will  be  few  situations  when  one  or  the 
other  of  these  approved  appliances  cannot  be  made  available.  A 
reserve  of  pure  water  in  the  Army  water-wagon,  the  Forbes  wagon 
sterilizer,  or  other  wheeled  receptacle  should  always  be  on  hand 
during  the  march  and  in  camp. 

As  an  army  advances  into  the  interior  of  an  unknown  or  hostile 
country,  it  is  not  practicable  to  make  a  complete  examination  of  all 
drinking  water.  A  rapid  chemical  analysis,  however,  such  as  can 
be  made  in  an  hour  or  two,  may  give  useful  indications  and  is  often- 
possible.  Therefore,  each  field  hospital  in  our  service  should  be 
provided  with  a  case  containing  the  necessary  reagents  and  appa- 
ratus to  that  end.  A  bacteriological  examination,  to  be  of  any 
value,  must  be  made  in  a  well-equipped  laboratory  not  liable  to 
frequent  and  sudden  changes,  and  therefore  is  not  possible  in  a  field 
hospital;  but  each  base  hospital  should  be  furnished  with  such  a 
laboratory,  made  detachable  and  portable  so  that  it  may  take  station 
outside  the  hospital,  wherever  most  needed. 


GENERAL    SANITARY    RULES    IN    THE    FIELD. 


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PLAN 

FIG.  230. —  Plan  for  kitchen  and  dining-room  in  permanent  camp. 
Quartermaster  Corps. 


68o  MILITARY    HYGIENE. 

3.  Great  concentrations  of  troops  should  be  avoided  and  camps 
made  as  small  as  possible,  scattering  brigades  and  divisions  as  much 
as  the  topography  of  the  country  and  the  exigencies  of  the  situation 
will  permit.     In  the  presence  of  the  enemy,  troops  are  necessarily 
strung  out  in  thin  lines,  making  large  camps  impossible.     One  of  the 
secrets  of  the  good  health  of  the  Russian  and  Japanese  soldiers  in 
Manchuria,  as  well  as  of  the  belligerent  troops  now  in  Europe,  is 
the  thinness  of  their  extended  lines,  seldom  more  than  a  battalion 
or  regiment  being  camped  together. 

Wherever  crowding  and  promiscuity  cannot  be  prevented,  greater 
care  must  be  given  to  the  early  detection  and  segregation  of  infec- 
tious diseases;  even  cases  of  common  colds,  cough,  sorethroat  and 
other  apparently  trivial  ailments  had  better  be  removed  from  their 
tents  and  treated  in  hospital. 

4.  Personal  hygiene,  that  is  to  say,  cleanliness  of  body  and  cloth- 
ing, is  very  desirable  in  the  field  although  often  difficult  of  attain- 
ment.    The  men  should  not  only  bathe  themselves,  but  also  wash 
their  linen  whenever  the  opportunity  offers  so  that  it  may  always  be 
as  fresh  and  clean  as  conditions  permit.     Then  not  only  will  they 
save  themselves  and  comrades  from  vermin,  especially  the  noisome 
louse,  transmitter  of  typhus  fever,  but  also  from  possible  contami- 
nation by  germs  of  typhoid  fever,  cholera  or  dysentery;  further- 
more, in  case  of  a  battle,  they  will  be  much  less  likely  to  suffer 
from  wound  infection,   for  this  dangerous  complication  is  nearly 
always  the  result  of  dirty  skin  and  clothing.     It  is  not  amiss  to 
add,  in  this  connection,  that  soldiers  should  always  go  into  a  fight 
with  empty  bowels  and  bladder  so  that,  if  shot  through  the  abdomen, 
the  danger  of  extravasation  and  peritonitis  be  reduced  to  a  mini- 
mum.    The  hands  are  the  most  dangerous  agent  of  disease  trans- 
mission in  camp  and  therefore  must  be  frequently  washed. 

5.  As  fully  explained  under  Latrines,  the  greatest  danger  to  which 
troops  in  camps  are  exposed  is  from  infected  human  excreta ;  their 
proper  disposal  must  always  be  one  of  the  chief  preoccupations  of 
sanitary  officers.     Whenever  a  case  of  infectious  disease  is  detected 
in  a  company  or  regiment,  the  most  effective  course  to  pursue  is  to 
remove  the  patient  promptly  to  a  field  or  base  hospital,  thus  pre- 
cluding, in  a  large  measure,  the  possibility  of  transmission  to  other 
men.     By  vigilantly  attending  to  this  prompt  segregation  of  first 
cases  and,  at  the  same  time,  keeping  under  observation  the  men  who 


GENERAL    SANITARY    RULES    IN    THE    FIELD.  68l 

have  been  in  contact  with  them,  no  epidemic  or  serious  outbreak  of 
any  camp  disease  is  likely  to  occur. 

6.  Bearing  in  mind  the  agency  of  flies  and  mosquitoes  in  the  con- 
veyance of  infection,  it  will  be  well,  so  far  as  means  permit,  to  screen 
with  wire  netting  all  the  buildings,  sheds  and  tents  which  need  most 
protection,  namely,  mess-sheds,  kitchens,  latrines  and  lavatories.     It 
is  especially  necessary  that  the  food,  while  being  prepared  and  con- 
sumed, be  suitably  guarded.     By  the  use  of  the  mosquito-bar,  ma- 
larial fever,  formerly  the  most  prevalent  of  camp  diseases,  is  now 
the  most  preventable  and  the  least  dangerous;  the  mosquito-bar, 
therefore,  has  become  part  of  the  equipment  of  the  soldier,  as  much 
so  as  his  blanket  and  first-aid  packet,  and  its  persistent  use  in  camp, 
wherever  mosquitoes  are  present,  must  be  insisted  upon.     When 
these  insects  are  troublesome,  a  head-net  also  becomes  absolutely 
necessary,  especially  for  men  on  guard.     In  the  Russo-Japanese  War 
such  a  net  was  issued  to  each  Japanese  soldier  with  his  summer  uni- 
form; it  was  collapsible  and  carried  tied  to  the  belt. 

7.  The  cleaning,  policing  and  disinfection  of  the  camp  grounds 
should  be  the  first  daily  duty  of  the  troops  after  breakfast.     Every 
part  should  be  carefully  inspected  and  receive  the  treatment  it  re- 
quires.    All  organic  dust,  but  especially  decaying  animal  and  vege- 
table matter,  must  be  swept  or  scraped  up  and,  with  all  other  garbage 
and  refuse,  including  tin  cans,  carted  to  the  incinerator.     It  is  upon 
such  decaying  matter  that  fleas  and  other  vermin  grow  and  multiply. 
Wherever  the  soil  has  been  fouled  by  urine  or  slops,  it  should  be 
sprinkled  over  with  lime  or  clean  earth.     Ditches  must  be  cleaned 
and  all  stagnant-water  puddles  drained  or  filled  up.     Disease  germs 
on  or  in  soil  which  is  pounded  into  dust  by  the  tramping  of  men  and 
animals  are,  of  course,  easily  blown  about  so  that  a  neglected  camp 
is  a  menace  not  only  to  itself,  but  to  all  its  neighbors.     A  camp 
should  be  kept  as  scrupulously  clean  as  military  exigencies  permit, 
but  the  custom,  much  too  common,  to  sweep  the  entire  grounds  every 
morning  and  raise  clouds  of  dust  is  distinctly  objectionable  and 
insanitary;  many  of  the  germs  are  simply  scattered  over  a  larger 
area,  not  removed.     Dirt  can  be  picked  up,  raked  or  scraped,  or 
swept  in  places,  after  sprinkling,  but  indiscriminate  sweeping  should 
not  be  tolerated  in  camps  any  more  than  in  city  parks. 

The  use  of  tar  oil  on  roadways  and  drill  grounds,  within  and 
around  the  camp,  is  highly  commended. 


682  MILITARY    HYGIENE. 

8.  How  often  should  a  camp  be  moved ;  that  is  to  say,  when  does 
a  camp,  from  mere  occupancy,  become  so  fouled  and  infected  as  to 
require  its  abandonment?  This  depends  largely  upon  the  manner 
and  extent  of  its  sanitation.  A  camp  may  be  so  well  provided  with 
conveniences,  so  well  policed  and  safeguarded  against  the  invasion 
and  propagation  of  infectious  diseases,  as  to  be  fully  as  healthy  as  a 
properly  governed  post  or  cantonment ;  in  such  case  there  is  no 
reason  for  change  of  site.  Thus  during  our  occupation  of  Cuba, 
after  the  Spanish  War  of  1898,  camps  were  kept  on  the  same  sites 
for  more  than  a  year  with  marked  benefit  to  the  health  of  the  troops, 
notwithstanding  the  depressing  effect  of  a  tropical  climate.  The 
crowded  camp  site  at  San  Antonio,  in  1910,  when  vacated  after  four 
months  of  continuous  occupation,  presented  nothing  offensive  to 
sight  or  smell  (/.  R.  Kean}.  The  rule  is  that,  with  a  good  site  and 
good  sanitation,  a  camp  can  be  occupied  indefinitely. 

There  is  a  change,  however,  within  the  camp,  which  is  always  prac- 
ticable and  beneficial.  Even  with  good  police  the  soil  areas  covered 
by  the  tents  are  likely  to  remain  damp  and  to  become  contaminated 
by  various  kinds  of  organic  matter.  Therefore  it  is  well,  now  and 
then,  to  shift  the  tents  to  the  immediately  adjoining  grounds,  while 
preserving  the  relative  arrangement  of  the  company  street,  so  that 
the  uncovered  soil  may  be  exposed  to  air  and  sun ;  at  the  end  of  a 
week  or  two  they  are  replaced  upon  the  original  sites. 

The  sanitary  reasons  requiring  the  removal  of  permanent  camps 
are  the  following:  When,  through  bad  sanitation,  especially  bad 
management  of  latrines,  the  soil  has  become  polluted  with  fecal 
matter  and  urine,  or  impregnated  with  decayed  organic  matter,  and 
therefore  a  dangerous  medium  for  the  multiplication  of  disease 
germs;  when  the  water-supply  is  infected  and  means  of  purifying 
it  are  inadequate;  when  the  site  is  so  situated  that  it  receives  the 
drainage  of  camps  on  higher  grounds ;  when,  through  irremediable 
causes,  flies,  mosquitoes,  or  other  insects  are  very  troublesome; 
finally,  when,  another  good  site  being  available,  it  is  deemed  desirable 
to  give  the  troops  a  change  of  surroundings  and  active  occupation 
for  awhile. 


CHAPTER    LVI. 
ADMINISTRATION  OF  THE  SANITARY  SERVICE  IN  THE  FIELD. 

This  subject  is  governed  by  the  Field  Service  Regulations 
(sections  329-353,  1914). 

The  senior  medical  officer  of  an  army  or  smaller  command  is 
charged  with  the  general  control  of  the  sanitary  troops  serving 
therewith,  and  commands  the  independent  sanitary  units.  He  may 
be  authorized  by  the  commander  to  make  assignments  of  the  per- 
sonnel, and  in  emergencies  the  entire  sanitary  service  of  the  com- 
mand may  be  placed  at  his  disposition. 

Before  troops  are  sent  to  camps  of  mobilization  they  must  be 
carefully  examined  by  medical  officers  of  the  regular  army  when 
practicable,  otherwise  'by  militia  or  volunteer  medical  officers  espe- 
cially detailed  for  this  duty,  to  detect  and  remove  cases  of  infec- 
tious diseases,  especially  typhoid  fever.  The  spread  of  such  dis- 
eases, in  camps,  during  a  campaign,  might  seriously  impair  the 
strength  and  mobility  of  a  command.  This  medical  inspection  is 
made  after  the  assembling  of  the  regiment  at  some  convenient 
point  (usually  a  general  concentration  or  mustering  rendezvous), 
and  within  2  or  3  days  of  starting  for  the  camp.  At  the  same  time, 
every  man  not  already  protected  is  vaccinated  against  small-pox  and 
typhoid  fever.  A  certified  record  of  this  inspection  and  vaccination 
is  kept  by  the  regimental  commander  for  the  information  of  the 
camp  commander. 

One  sanitary  inspector,  on  the  recommendation  of  the  Surgeon 
General,  is  assigned  to  each  division.  (Sect.  331,  F.  S.  R.) 

It  is  the  duty  of  commanders  to  remedy  sanitary  defects  re- 
ported to  them  by  sanitary  inspectors.  To  facilitate  the  attainment 
of  proper  results  in  sanitary  emergency,  a  sanitary  inspector  may 
be  authorized  by  the  commander  of  the  unit  to  which  he  is  assigned, 
to  direct,  in  the  name  of  the  latter,  and  within  such  limitation  as 
the  commander  may  prescribe,  the  prompt  abolition  of  conditions 
prejudicial  to  the  health  of  troops. 

It  is  now  recognized,  in  jour  service,  that  military  hygiene  is 
specialized  knowledge  and  that  only  medical  officers  are  competent 

683 


684  MILITARY    HYGIENE. 

to  direct  and  supervise  its  application.  The  former  method  of  turn- 
ing over  much  of  the  sanitary  work  to  the  Q.  M.  Corps  caused 
a  divided  responsibility  which  bred  indifference  and  prevented  the 
attainment  of  the  best  results.  The  Medical  Department  possesses 
the  autonomy  which  is  essential  for  the  successful  discharge  of  its 
manifold  duties.  It  exercises  complete  control  not  only  over  its 
own  personnel  and  material,  but  also  upon  'the  civilian  laborers  and 
means  of  transportation  temporarily  transferred  to  it,  when  neces- 
sary, by  the  Q.  M.  Corps. 

Experience  has  shown  that,  in  the  field,  the  best  sanitary  service 
is  obtained  by  the  organization  of  regimental  sanitary  squads,  each 
consisting  of  one  Hospital  Corps  sergeant,  one  Hospital  Corps 
private  from  each  company,  and  as  many  hired  laborers  as  may  be 
necessary,  under  the  control  of  the  regimental  sanitary  officer. 
Where  laborers  cannot  be  procured,  special  details  must  be  made 
from  the  companies.  The  squad  performs  all  the  sanitary  work 
of  the  regiment. 

The  Hospital  Corps  non-commissioned  officers  and  privates  of  the 
squad  are  specially  instructed  in  the  installation  and  operation  of 
filters,  the  construction  and  operation  of  company  incinerators,  the 
digging,  policing  and  disinfection  of  latrines  and  urinals,  the  treat- 
ment of  wastes,  care  of  grounds,  picket  lines,  etc.  They  give  prac- 
tical demonstrations  in  all  these  subjects  and  supervise  the  work  of 
police  and  fatigue  parties  so  far  as  may  be  necessary. 

In  addition  to  the  regimental  squads,  a  general  sanitary  squad  is 
necessary  for  the  proper  care  of  camp  areas  beyond  the  supervision 
of  regimental  sanitary  officers. 

As  model  of  a  divisional  sanitary  order,  brief  but  comprehensive, 
showing  the  general  scheme  of  camp  sanitation  and  the  duties  and 
responsibilities  of  the  Medical  Department  under  the  circumstances, 
the  following  is  quoted : 

HEADQUARTERS  MANEUVER  DIVISION, 
GENERAL  ORDERS,]  San  Antonio,  Texas, 

No.  2.  j  (Date.) 

The  following  regulations  for  camp  sanitation  are  published  for  the  infor- 
mation and  guidance  of  all  concerned: 

1.  CHIEF  SURGEON.     The  Chief  Surgeon  is  charged  with  the  general 
conduct  and  supervision  of  the  Medical  Department  in  the  performance  of 
its  duties,  and  will  make  such  assignment  of  personnel  as  may  be  required. 

2.  THE  SANITARY  INSPECTOR.     The  Sanitary  Inspector  is  charged 


ADMINISTRATION    OF   THE    SANITARY    SERVICE    IN    THE    FIELD.     685 

especially  with  the  supervision  of  the  sanitation  of  the  camp.  It  is  the  duty 
of  commanders  to  remedy  defects  reported  to  them  by  the  inspector,  in 
conformity  with  Section  331,  F.  S.  R. 

3.  REGIMENTAL    SURGEONS.       The    senioi    medical    officer    of    each 
command  will  make  at  least  one  inspection  daily  of  the  command  to  which 
attached,  and  report  any  sanitary  defects,  with  proper  recommendations  to 
remedy  the  same,  to  his  commanding  officer,  who  will  immediately  take  the 
necessary  steps  for  their  correction,  if  within  his  authority.    If  beyond  his 
facilities,  or  if   considered   impracticable,   he   will   immediately    forward   the 
report,  with  full  remarks,  for  action  of  higher  authority. 

4.  WATER   SUPPLY.     The  camp   water   supply  is  pure  and  wholesome 
and   no    sterilization  of    drinking   water   is   necessary.     Precaution   must   be 
taken,   however,   to  prevent   subsequent   contamination   by  keeping  all   con- 
tainers  scrupulously  clean  and  protected   from  dust  and  other  sources  of 
infection. 

5.  DISPOSAL    OF    EXCRETA    AND    WASTES.      Organization    com- 
manders will  be  held  responsible  for  the  police  of  their  respective  camps. 
Each   company   or   similar   organization  will   construct  incinerators   for   the 
disposal  of  all  solid  and  liquid  garbage  of  the  organization,  and  no  other 
disposition  will  be  made  of  such  wastes.     Human  excreta  will  be  disposed 
of  in  pits  provided  with  latrine  boxes  unless  other  provision  has  been  made. 
Two  urinal  cans   will  be  placed  in  each  company  street  at  night.     Latrine 
pits  will  be  burned  out,  and  seats  scrubbed  daily;    crude  oil  and  straw  or 
other  material  will  be  used.     The  urinal  cans  will  be  burned  out  daily  and  bot- 
toms covered  with  milk  of  lime  before  put  in  use.     Defilement  of  the  ground 
in  or  about  the  camp  is  absolutely  prohibited.     Manure  will  be  hauled  to  a 
designated   dumping   ground,    and  there   burned   in    the   manner  prescribed. 
Rock  pit  crematories  will  be  used  for  disposal  of  general  wastes  of  camp 
areas  not  under  the  jurisdiction  of  commanding  officers. 

6.  FOOD -AND  DRINKS.     No  food,  drinks,  or  like  commodities  will  be 
sold  in  camp  except  in  the  authorized  exchanges. 

7.  SANITARY  SQUADS.     Sanitary  squads  composed  of  medical  officers, 
non-commissioned    officers,    and    privates    of    the    Hospital    Corps'  will    be 
organized  by  the  Chief   Surgeon.     The  Sanitary   Squad  will   supervise  and 
assist  in  the  disposal  of  camp  wastes.     Civilians  employed  as  sanitary  laborers 
will   be    employed   by   the    Quartermaster    Corps    and    turned   over   to    the 
Medical  Department.     The  Sanitary  Police  Officer  will  make  requisition  on 
the  Chief  Quartermaster  for  such  transportation,  labor,  or  material  as  may 
be  needed.    When  assigned  to  this  service  they  will  not  be  diverted  to  other 
uses  except  by  order  from  these  headquarters. 

BY  COMMAND  OF  MAJOR  GENERAL  C : 

A.  B.  C 

Colonel,  General  Staff,  Chief  of  Staff. 


CHAPTER    LVII. 
SERVICE  IN  WARM  CLIMATES. 

The  territory  under  the  flag  of  the  United  States  extends  from 
northern  Alaska,  near  the  70°  latitude,  to  the  southern  Philippine 
Islands,  only  some  five  degrees  north  of  the  equator.  Within  these 
limits  is  the  greatest  variation  of  climatic  conditions,  from  a  mean 
annual  temperature  of  about  83°  F.  down  to  one  below  the  freezing 
point,  and  from  vapor-saturated  sea  islands  to  deserts  as  arid  as 
those  of  Africa.  It  must  be  borne  in  mind  that  extremes  of  tem- 
perature are  not  only  found  in  the  Philippine  Islands  and  Alaska 
but  exist  as  well  within  the  United  States.  Thus,  Manila  has  a  mean 
annual  temperature  of  80°  F.,  while  the  mean  of  its  hottest  month, 
May,  is  only  83.5°,  and  the  maximum  of  any  day  during  this  month 
never  reaches  100°.  With  this  may  be  compared  the  summer  means 
(May  to  September  inclusive)  of  Fort  Yuma,  Ariz.,  86.26°,  and 
Laredo,  Texas,  84.10°.  Furthermore,  a  maximum  temperature  ex- 
ceeding 100°  F.  may  be  expected,  with  few  exceptions,  in  any  city  of 
the  United  States  south  of  New  York  and  Chicago ;  while,  in  the 
southwest,  a  maximum  of  105°  to  115°  is  not  rare.  However,  the 
combination  of  high  temperature  and  great  humidity  only  exists  in 
our  South  Atlantic  and  Gulf  States,  and  these  may  be  truly  said  to 
have  a  tropical  summer  climate,  a  climate  indeed  often  more  trying, 
from  the  absence  of  air  movement,  than  that  of  Manila,  Havana  or 
Porto  Rico  always  fanned  by  the  trade-winds.  On  the  other  hand, 
parts  of  the  United  States  suffer  from  extreme  cold  during  the 
winter,  the  thermometer  falling  to  — 40°,  or  even  lower,  in  some  of 
the  northern  States.  This  extreme  variation  of  temperature,  from 
torrid  heat  to  Arctic  cold  is  the  most  striking  feature  of  the  conti- 
nental climate  of  the  United  States.  The  records  of  the  Weather 
Bureau  show  that,  for  the  decade  1898-1908,  the  lowest  annual  mean 
of  any  station  in  the  United  States,  namely,  35.7°,  was  at  Pembina, 
N.  D.  (49°  lat.).  During  that  period,,  the  highest  temperature 
recorded  at  that  place  was  103°  in  June,  and  the  lowest,  — 43°  in 
January,  a  range  of  146°.  But  even  those  States  with  the  highest 
summer  temperature  have  a  comparatively  cold  winter,  often  down 

686 


SERVICE   IN    WARM    CLIMATES.  687 

to  frost,  which  partly  neutralizes  the  effects  of  the  summer  heat  and 
prevents  the  deteriorating  influence  on  the  human  system  often  seen 
in  true"  tropical  regions. 

The  climatic  conditions  characteristic  of  the  tropics  are  constant 
high  temperature  and  relative  humidity,  actinic  action  of  solar  rays, 
bright  luminosity  and  great  electric  tension. 

High  temperature  alone  does  not  render  a  climate  unhealthy. 
Among  the  most  salubrious  parts  of  the  United  States  are  the  arid 
regions  of  the  Southwest  where  the  thermometer  ranges  up  to  1 10° 
and  above  in  the  shade.  The  factor  which  plays  the  most  important 
part  in  the  deteriorating  influence  of  tropical  climates,  and  is  im- 
possible to  guard  against,  is  humidity,  that  is,  a  constant,  high  rela- 
tive humidity.  Furthermore,. these  two  elements,  heat  and  humid- 
ity, must  be  present,  within  limited  variations,  throughout  the  year. 
Thus  the  annual  mean  relative  humidity  of  Manila,  P.  I.,  is  80.2 
(ranging  from  71  in  April  to  85  in  September).  The  nearest  ap- 
proach to  it,  in  the  United  States,  is  that  of  our  Gulf  Coast  in 
summer  (72.3  in  New  Orleans,  in  July). 

To  prevent  the  temperature  of  the  body  from  rising  above  its 
normal  point,  nature  provides  for  the  dissipation  of  surplus  heat  in 
two  ways:  by  transfer  (through  radiation,  conduction  and  convec- 
tion) and  by  evaporation  of  the  sweat.  The  loss  by  transfer  varies 
with  the  difference  of  temperature  between  the  body  and  surround- 
ing air,  being  greatest  in  cold  weather.  With  a  temperature  of  70°, 
or  under,  the  loss  takes  place  chiefly  'by  radiation  and  conduction. 
As  the  temperature  rises  above  this  degree  and  approximates  that 
of  the  body,  evaporation  assumes  the  more  important  part.  •  Through 
the  delicate  nervous  mechanism  whereby  the  temperature  is  regu- 
lated, more  blood  flows  to  the  surface  and  more  sweat  is  excreted, 
and  it  is  on  the  evaporation  of  this  sweat  that,  in  hot  weather,  the 
body  must  chiefly  depend  to  keep  its  temperature  down  to  the  normal 
point.  Rubner  calculates  that  a  stout  man,  in  summer,  may  thus 
lose  3,200  calories  in  a  day,  the  equivalent  in  heat  of  the  amount 
generated  by  an  ordinary  military  ration.  So  long  as  this  evapora- 
tion is  free,  the  degree  of  solar  heat  does  not  matter  and  the  body 
functions  remain  unaffected.  Thus  a  temperature  greatly  exceeding 
100°  is  not  oppressive  in  the  very  dry  air  of  New  Mexico  and 
Arizona.  Very  different  is  the  result  in  the  moist  atmosphere  of  the 
tropics:  there  the  skin  and  lung  evaporation  is  greatly  impeded. 


688  MILITARY    HYGIENE. 

Not  only  does  a  high  degree  of  humidity  interfere  with  evaporation 
but  likewise  with  radiation  from  the  body.  It  is  true  that,  on  the 
other  hand,  it  favors  conduction,  since  moist  air  is  a  better  conductor 
of  heat  than  dry  air,  but  such  conduction  is  a  poor  substitute  for  the 
greatly  impaired  radiation.  This  failure  of  heat  dissipation  results 
in  an  increase  of  body  temperature  which  is  further  added  to  and 
aggravated  by  the  more  active  metabolism  thus  produced. 

The  dangerous  effect  of  this  increased  temperature,  however,  is 
probably  mitigated  by  the  depletion  of  internal  organs  caused  by  the 
rushing  of  blood  to  the  skin  to  facilitate  loss  of  heat  by  evaporation 
and  radiation.  Owing  to  the  close  correlation  existing  between  the 
circulation  of  the  skin  and  of  the  brain,  the  latter  organ  is  especially 
affected,  and  to  its  depletion  should  be  chiefly  attributed,  according 
to  some  physiologists,  the  dull  feeling,  listlessness  and  discomfort 
of  a  muggy  summer  day, 

The  physiological  effects  of  moist  heat  are  well  shown  by  the  ex- 
periments of  Phalen  at  Los  Banos,  P.  L*  Four  able-bodied  men 
were  subjected  for  4  hours  to  a  temperature  92°  to  98°  in  a  room 
saturated  with  moisture  but  otherwise  well  ventilated.  They  were 
clothed  in  thin  underwear  and  allowed  to  recline  or  walk  as  they 
preferred.  The  loss  in  weight  averaged  3.25  pounds  and  the  loss  of 
strength  (as  measured  by  the  ergometer)  38  per  cent.  In  each  case 
there  was  a  notable  rise  in  pulse,  respiration  and  temperature,  as 
well  as  a  fall  in  blood  pressure.  Sweating  was  very  profuse  and 
the  clothing  was  soon  saturated.  All  the  men  felt  tired  and  relaxed 
and  had  no  appetite  for  the  next  meal,  but  denied  the  presence  of 
headache  or  other  disagreeable  symptoms,  and  were  in  their  normal 
condition  the  next  day. 

This  observer  also  reports  the  result,  on  a  baseball  team,  of  hard 
practice  for  two  hours  at  a  temperature  of  about  93°,  with  relative 
humidity  of  approximately  80,  under  a  cloudless  sky  and  in  a  mod- 
erate breeze.  The  average  temperature  of  the  men  was  99.7°,  the 
lowest  being  99°  and  the  highest  100.4°.  The  blood  pressure  rose 
from  120.7  to  129.5  mm-  This  record  hardly  differs  from  what 
would  be  expected  after  a  similar  game  played  on  a  warm  day  in 
the  United  States,  and  shows  the  possibility  of  strenuous  exercise 
even  in  the  tropics  if  not  too  long  continued. 

*  J.  D.  Phalen,  Philippine  J.  of  Sc.,  Dec.,  1910. 


SERVICE    IN    WARM    CLIMATES.  689 

Whatever  may  be  the  degree  of  atmospheric  humidity  in  hot 
countries,  relief  is  always  afforded  by  agitation  of  the  air.  Any 
breeze  or  wind  increases  the  evaporation  and  radiation  from  the 
body  and  thus  reduces  its  temperature.  Fortunately,  it  happens  that 
tropical  countries  are  nearly  constantly  swept  by  monsoons  and 
trade-winds  so  that  there  are  few  where  the  white  man,  by  using 
the  means  suggested  by  ordinary  intelligence,  cannot  live  in  safety 
and  comfort,  so  far  as  climatic  conditions  are  concerned. 

One  of  the  effects  of  the  greatly  increased  perspiration  is  a  dimi- 
nution of  urine  and  of  the  digestive  fluids.  The  urea  is  lessened, 
but  this  is  mostly,  if  not  entirely,  from  lessened  food. 

In  spite  of  the  more  abundant  perspiration,  the  skin  evaporation 
seems  unable  to  prevent  a  rise  of  body  temperature  in  new-comers, 
amounting  to  half  a  degree  or  more ;  but  gradually  the  system 
adjusts  itself  to  its  new  conditions  so  that,  in  a  year  or  two,  the 
temperature  is  again  normal. 

Under  the  direct  rays  of  the  hot  sun  the  skin  becomes  moist  with 
perspiration,  but  should  the  exposure  continue  and  the  natural  cool- 
ing processes  of  the  body  be  interfered  with,  the  sweat  becomes 
checked  and  the  skin  dry,  one  of  the  first  symptoms  of  heatstroke. 

According  to  the  observations  of  Wickline  and  other  members  of 
the  Medical  Corps,  U.  S.  Army,  made  on  104  American  officers  and 
enlisted  men,  in  the  Philippines  (Mil.  Surgeon,  October,  1908),  the 
composition  of  the  blood  undergoes  notable  changes.  In  86  per  cent, 
of  all  men  examined,  the  hemoglobin  was  decreased  from  94  per  cent, 
at  the  first  examination  to  83  per  cent,  at  the  last,  nearly  2  years 
later.  The  erythrocyte  count,  on  the  contrary,  was  increased  up  to 
an  average  of  5.640,000.  The  most  remarkable  change  was  found  to 
occur  in  the  differential  leukocyte  count,  consisting  in  the  continuous 
decrease  of  polymorphonuclears,  from  64.4  down  to  an  average  of 
54  per  cent.,  with  a  relative  increase  in  the  small  lymphocytes  and 
eosinophiles.  This  low  percentage  of  the  phagocytic  polymorphonu- 
clear  elements,  which  also  appears  to  be  the  normal  condition  of  the 
natives  of  tropical  countries,  may  account  for  their  relative  lack  of 
resistance  to  certain  infectious  diseases,  and  gives  point  to  Cabot's 
remark:  "  It  would  appear  that  the  degree  of  health  in  persons  not 
organically  diseased,  might  perhaps  prove  to  vary  directly  with  the 
percentage  of  polymorphonuclear  cells  in  the  blood." 

The  number  of  respirations,  in  Wickline's  observations,  shows  an 


690  MILITARY    HYGIENE. 

increase,  with  an  average  of  19.6  per  minute.  The  pulse  rate  is  not 
reported,  but  it  may  be  assumed  that,  if  changed  at  all,  it  is  slightly 
increased  in  harmony  with  that  of  respiration. 

Phalen's  observations*  corroborate  those  of  Wickline. 

Those  of  Chamberlain  and  Vedder/f  based  on  a  large  number  of 
men,  yield  somewhat  different  results.  After  20  months  of  Philip- 
pine service,  700  American  soldiers  living  near  sea  level,  showed  a 
red-cell  count  of  5,200,000  per  c.  m.,  a  hemoglobin  reading  of  89.6 
per  cent.,  and  a  color  index  of  0.86.  Such  red-cell  count,  Dr.  Cham- 
berlain concludes,  "  does  not  differ  from  the  normal  at  present  recog- 
nized for  healthy  young  men  in  the  temperate  zone.  The  hemo- 
globin percentage  and  the  color  index  are  probably  a  little  low,  but 
not  sufficiently  so  to  indicate  a  definite  anemia.  The  pallor  not  in- 
frequently met  with  among  apparently  healthy  persons  in  the  tropics 
we  believe  to  be  due  as  a  rule  to  superficial  ischemia  and  not  to  a 
deficiency  in  the  total  quantity,  or  in  any  particular  constituent,  of 
the  blood." 

Chamberlain  and  his  colleagues  also  found  that*  the  blood-pressure 
of  Americans  in  the  Philippines  differs  little  if  at  all  from  the  aver- 
age at  home.  The  body  temperature,  after  19  months'  service  in 
the  Islands,  averaged  98.74°,  which  is  less  than  0.2  over  the  gen- 
erally recognized  mean  of  98.6°.  The  pulse  rate  for'  both  races, 
white  soldiers  and  Filipinos,  averaged  a  few  beats  above  the  usual 
standard  of  72  per  minute. 

The  expansion  or  rarefaction  of  the  air  caused  by  the  heat  in  the 
tropics,  reduces  the  amount  of  oxygen  contained  in  it  to  an  extent 
of  about  3  per  cent.  Since  the  hemoglobin  of  the  blood  is  the 
oxygen-carrier- to  the  tissues,  its  decrease  further  reduces  the  amount 
of  oxygen  which  becomes  available  for  the  system,  and  the  capacity 
of  the  lungs  to  eliminate  carbon.  To  make  up  to  a  great  extent  for 
this  deficiency,  nature,  as  stated  above,  increases  the  number  of  red 
blood-cells,  together  with  the  number  of  respirations,  as  it  does  in 
people  residing  at  high  altitudes.  It  has  been  proved  that  the  higher 
the  temperature  the  more  active  the  respiration,  that  is  to  say,  the 
greater  the  ventilation  of  the  lungs  and  output  of  CO2.  Regarding 
the  increase  of  erythrocytes,  however,  Phalen  inclines  to  the  belief 
that  it  is  only  apparent,  being  due  to  excessive  perspiration  and 

*  Loc.  cit. 

t  Philippine  J.  of  Sc.,  Sec.  B,  vi,  1911. 


SERVICE   IN    WARM    CLIMATES.  69! 

resulting  concentration  of  the  blood,  rather  than  to  an  actual  aug- 
mentation of  cells. 

Of  101  men  examined  by  Wickline,  it  was  found  that,  at  the  end 
of  about  2  years,  82  had  lost  an  average  of  8.1  pounds,  4  showed  no 
change,  while  15  showed  an  average  gain  of  6  pounds.  In  200  men 
examined  by  Chamberlain,  the  loss  in  weight  during  the  first  year 
was  3.2  pounds. 

Some  of  the  effects  of  tropical  heat  upon  men  and  animals  have 
been  observed  by  Hans  Aron  at  Manila,  P.  I.  He  found  that 
monkeys  exposed  to  the  sun  show  a  steady  rise  of  temperature  and 
die  in  about  an  hour,  with  hemorrhages  of  the  brain  and  heart. 
Dogs  and  rabbits  succumbed  in  a  few  hours  with  hyperemia  and 
small  hemorrhages  of  the  brain  and  meninges.  If  care  is  taken  to 
conduct  away  the  excessive  heat  increment  by  brisk  fanning,  the 
body  temperature  remains  approximately  normal  and  the  animals 
do  not  suffer.  Exposure  of  the  head  alone  is  not  fatal  so  long  as 
the  rest  of  the  body  is  kept  cool. 

If  the  effect  of  sunlight  in  such  fatal  cases  were  to  be  attributed 
to  the  absorption  of  the  ultraviolet,  or  actinic,  rays,  as  has  been  con- 
tended, their  influence,  it  is  claimed,  would  not  thus  be  completely 
neutralized  by  a  current  of  air.  Such  deduction,  however,  is  not 
convincing.  It  is  very  probable  that  the  actinic  rays  make  them- 
selves felt  on  the  body  only  at  a  high  temperature,  and  that  any 
artificial  cooling  of  the  skin  prevents  their  action. 

The  temperature  of  the  skin,  in  man,  normally  about  91°,  rises 
quickly  upon  exposure  to  the  sun,  to  about  97°,  at  which  point  the 
sweat  breaks  out;  there  it  stops  or  even  declines  if  perspiration  is 
free.  In  the  hair  of  an  uncovered  head  the  temperature  increases 
enormously,  and  as  but  little  perspiration  takes  place  in  the  scalp, 
no  fall  occurs.  In  the  black  dense  hair  of  a  native,  it  rose  to  113° 
F.  within  30  minutes,  and  to  122°  within  an  hour.  The  necessity 
of  protecting  the  head  from  the  solar  rays  is  thus  conclusively 
demonstrated.  In  the  sun,  perspiration  is  so  great  that  a  man  lying 
down  quietly,  lost  280  grams  in  weight  in  an  hour,  without  counting 
the  moisture  absorbed  by  the  clothing.  The  pulse  rate  of  a  man 
sitting  quietly,  increased  10  to  12  beats  a  minute,  while  the  quantity 
of  air  respired  also  increased  23  per  cent.,  namely,  from  317  c.  c.  in 
the  shade,  to  390  in  the  sun. 

The  effect  of  a  tropical  climate  upon  the  nervous  system  is  notice- 


692  MILITARY    HYGIENE. 

able  in  susceptible  people,  causing  general  depression  and  loss  of 
vital  energy,  with  tendency  to  neurasthenia  and  mental  irritability. 
There  is  no  evidence  that,  so  far  as  Americans  are  concerned,  blonds 
are  oftener  or  more  seriously  affected  than  brunettes. 

To  sum  up,  it  may  be  stated  as  an  accepted  fact  that  in  our  colo- 
nies, as  in  other  tropical  countries,  from  climatic  conditions  alone, 
irrespective  of  endemic  disease,  the  endurance  of  the  North  Ameri- 
can is  put  to  a  severer  test,  while  he  is  generally  incapable  of  the 
same  mental  and  muscular  exertion.  Our  views  on  this  subject, 
however,  have  had  to  be  somewhat  modified  and  readjusted  to  the 
results  obtained  in  the  Panama  Canal  Zone,  demonstrating  to  what 
an  astonishing  extent  the  so-called  deteriorating  climatic  effects  of 
the  tropics  are  preventable.  Gorgas  reports  that,  after  the  elimina- 
tion of  yellow  fever  and  malarial  fever,  and  the  enforcement  of  all 
reasonable  sanitary  measures  in  the  Zone,  the  American  employes 
have  become  hardy,  rugged,  active  and  energetic,  with  a  mortality 
as  low  as  that  of  the  healthiest  regions  of  the  United  States  (see 
Chapter  I). 

Soldiers  sent  to  the  tropics  should  be  picked  men,  in  good  physical 
condition  and  not  less  than  22  years  old ;  younger  men  have  but  little 
power  of  endurance  and  are  more  susceptible  to  infectious  diseases. 
They  should  arrive  at  the  beginning  of  the  dry  and  cold  season, 
usually  November  or  December,  so  that  they  may  partly  adapt  them- 
selves to  their  new  surroundings  before  the  advent  of  summer. 
The  sanitary  conditions  under  which  our  soldiers  in  the  colonies  are 
obliged  to  live  have  very  much  improved  of  late  years,  and  their 
power  of  resistance  to  the  depressing  effects  of  the  climate  have  cor- 
respondingly increased.  The  length  of  time  they  can  serve  in  the 
tropics  without  detriment  to  body  and  mind  cannot  be  definitely 
stated,  depending  as  it  does  upon  many  variable  factors,  but  there  is 
no  doubt  that,  under  ordinary  circumstances,  they  could  remain  at 
least  3  or  4  years  with  entire  impunity.  Statistics'  show  that  the 
longer  our  men  serve  in  the  Philippines,  up  to  10  or  more  years,  the 
smaller  is  their  ratio  of  non-effectives.  A  large  proportion  of  the 
English  troops  in  India  remain  from  5  to  8  years,  but  it  must  be 
noted  that  part  of  their  time  is  spent  at  posts  located  in  mountainous 
regions,  and  therefore  in  a  subtropical  if  not  temperate  climate. 
Their  statistics  show  that,  within  certain  limits,  the  longer  a  soldier 
remains,  the  less  susceptible  he  grows  to  his  pathogenic  surroundings, 


SERVICE   IN    WARM    CLIMATES.  693 

so  that  he  is  able  to  render  better  service  the  third  and  fourth  years 
than  the  first  and  second;  in  other  words,  in  healthy  men  of  good 
habits  a  marked  degree  of  physiological  acclimation  takes  place. 
The  War  Department,  in  reducing  the  term  of  service  of  our  soldiers 
in  the  Philippine  Islands  to  two  years,  has  doubtless  been  inspired 
by  other  considerations  than  the  mere  economic  and  sanitary  aspects 
of  the  subject.  However,  under  the  best  possible  conditions,  it  is 
obvious  that  white  troops,  sent  from  the  United  States  to  the  colo- 
nies, not  only  require  very  expensive  care  but  will  never  acquire  the 
natural  resistance  which  is  enjoyed  by  the  natives.  The  latter,  as 
the  experience  of  all  countries  has  shown,  if  well  trained  and  well 
officered,  will  make  excellent  and  reliable  troops  with  much  less 
effort  and  cost.  Therefore,  speaking  from  the  viewpoint  of  hygiene, 
the  easiest  way  to  reduce  the  mortality  rates  for  disease  in  our  colo- 
nies would  be  to  replace  the  white  troops  serving  therein,  as  far  as 
possible,  by  native  troops. 

FOOD.  —  The  food  suitable  for  warm  countries  has  already  beea 
discussed  (page  401).  There  can  be  no  doubt  as  to  the  principle 
that,  to  preserve  his  health  and  yield  his  greatest  efficiency  in  a  trop- 
ical climate,  the  soldier  must  reduce  his  daily  ration ;  but  this  prin- 
ciple is  very  imperfectly  understood  and,  in  practice,  carelessly 
observed.  Eating  is  to  a  large  extent  a  matter  of  habit,  and  men 
will  consume  the  same  quantity  of  food  they  have  been  accustomed 
to,  regardless  of  climate,  unless  their  attention  is  especially  called  to 
the  danger  of  such  indulgence. 

Not  only  the  system  does  not  require  so  much  food,  but  the  amount 
of  muscular  exercise  being  necessarily  reduced,  less  of  it  can  be 
metabolized  and  excreted,  so  that,  should  the  same  quantity  be  in- 
gested, the  system  gets  clogged,  while  an  unusual  amount  of  physio- 
logical work  is  thrown  upon  the  liver  and  kidneys  in  their  efforts  to 
get  rid  of  all  useless  waste  products.  A  condition  of  physiological 
hyperemia  is  brought  about  which  is  the  first  stage  of  the  "  tropical 
liver"  ;  this  condition  soon  passes  into  one  of  static  congestion  with 
diminished  functional  activity.  In  the  first  stage,  there  is  usually  a 
copious  flow  of  bile  with  perhaps  bilious  diarrhea,  but  in  that  of  con- 
gestion there  is  impaired  hepatic  action  and  those  digestive  disturb- 
ances which  result  from  lack  of  healthy  bile.  One  step  further  and 
congestion  may  pass  into  actual  inflammation,  or  hepatitis,  with 
enlargement  of  the  organ,  fever,  pain  and  tenderness  on  pressure. 


694  MILITARY    HYGIENE. 

The  reduction  of  food  should  be  chiefly  in  fats  and  meats  whose 
waste  products  throw  most  work  upon  the  already  strained  elimina- 
tive  organs.  Nitrogenous  food  is,  of  course,  everywhere  necessary, 
but,  in  the  tropics,  it  should  be  chiefly  supplied  by  fish,  poultry,  eggs, 
cereals  rich  in  gluten,  and  the  pulses  (beans,  peas  and  lentils,  indige- 
nous and  introduced)  ;  the  bulk  of  the  food  should  always  consist 
of  starchy  cereals,  fresh  vegetables  and  fruits. 

In  India,  sulphur  fumes  are  used  quite  successfully  to  prevent  the 
rapid  decomposition  of  meats  and  render  them  more  tender  (see 
page  335). 

BEVERAGES.  —  Concerning  beverages,  it  is  well  to  bear  in  mind  the 
French  axiom  that,  in  the  tropics :  "  To  seek  pure  water  and  shun 
alcoholic  drinks  is  the  beginning  of  wisdom."  No  water  should  be 
used  which  is  not  known  to  be  wholesome,  or  has  not  been  purified. 
More  of  it  is  necessary  in  warm  than  in  temperate  regions  so  as  to 
provide  for  the  increased  perspiration.  The  best  time  to  take  it  is 
between  meals,  and  in  the  morning  and  evening.  To  drink  much 
and  often  is  a  bad  habit,  disturbing  the  digestive  functions  and  weak- 
ening the  power  of  endurance.  Water  should  be  cooled  with  ice  so 
as  to  be  palatable  and  refreshing,  but  ice-cold  water  is  liable  to  pro- 
duce gastric  and  intestinal  troubles  and  always  dangerous  in  the 
tropics.  In  the  absence  of  ice,  water  can  be  cooled  by  the  usual 
native  methods,  namely,  by  letting  it  filter  or  ooze  through  a  porous 
earthern  jar  or  olla,  the  evaporation  of  the  fluid  on  the  surface 
abstracting  the  heat  of  the  jar  and  contents;  or  a  metal  receptacle 
can  be  used,  with  covering  of  felt  or  flannel  occasionally  wetted,  like 
the  soldier's  canteen.  The  process  of  evaporation  and  cooling  is 
much  more  rapid  if-  the  receptacle  be  hung  in  a  draft,  overnight. 
Incidentally,  the  olla  always  clarifies  the  water  and  may  also  materi- 
ally purify  it  if  brushed  inside  and  outside  and  sterilized  once  a  week. 

Alcoholic  drinks,  in  the  tropics,  should  be  entirely  discarded  or  else 
used  with  the  greatest  discretion.  They  throw  more  work  on  the 
liver  and  kidneys  already  overtaxed,  and  lower  still  further  the  ner- 
vous energy  already  depressed.  "Alcohol  is  a  predisposing  cause 
to  all  endemic  diseases;  on  this  point  all  authors  in  exotic  pathology 
are  unanimous;  in  epidemics,  the  intemperate  are  the  first  and 
surest  victims"  (Treille}.  There  is  no  objection  to  tea  and  coffee; 
they  will  furnish  all  the  stimulation  that  may  be  needed  under  most 
circumstances.  To  relieve  fatigue  and  quench  thirst,  on  a  hot  day, 


SERVICE    IN    WARM    CLIMATES.  695 

Englishmen,  Japanese  and  Russians  rely  mostly  on  tea.  Coffee 
and  tea  are  made  with  boiled  water  and  have  therefore  the  merit  of 
be/ng  sterilized  drinks.  For  this  purpose,  tea  will  admit  of  a  much 
higher  degree  of  dilution  than  coffee  (see  Coffee  and  Tea). 

SOLAR  BAYS. 

It  will  be  useful  to  remember  that  the  solar  spectrum  consists  of  a 
series  of  colors,  ordinarily  described  as  red,  orange,  yellow,  green, 
blue,  indigo  and  violet.  These  colors  result  from  the  dispersion  of 
the  rays  of  different  wave-lengths,  the  wave-length  of  the  extreme 
red  at  one  end  of  the  spectrum  being  about  twice  that  of  the  extreme 
violet  at  the  other  end.  Outside  the  visible  spectrum,  however, 
there  is  also  an  invisible  part  beyond  the  red,  called  the  infra-red 
region  with  much  greater  wave-length,  and  another  beyond  the  violet, 
called  the  ultra-violet  with  shortest  wave-length.  The  spectrum  has 
been  divided  into  three  parts  formed  respectively  by  the  invisible 
heat  rays,  the  luminous  rays  and  the  chemical  or  actinic  rays.  This 
division,  however,  is  more  or  less  arbitrary  for  all  rays  of  the  spec- 
trum are  heat  rays  and  possess  more  or  less  chemical  power.  It  is 
true,  nevertheless,  that  chemical  changes  are  most  stimulated  by  the 
violet  and  ultra-violet  rays,  and  least  by  the  red  and  orange. 

Of  late  years,  it  has  been  more  clearly  realized  that  the  solar  rays 
affect  animals  and  plants  in  their  threefold  power :  by  heat,  light  and 
actinic  or  chemical  action.  These  effects  are  probably  never  sepa- 
rated but  may  be  combined  in  greatly  varying  proportion.  That  heat 
alone  cannot  produce  all  the  symptoms  of  insolation  is  made  evident 
by  noting  the  effects  of  simple  artificial  heat  in  rolling-mills  and  the 
fire-rooms  of  ships  where  the  temperature  not  infrequently  rises  to 
200°  F.  Such  heat  is  borne,  for  short  periods  of  time,  without  in- 
jury. On  the  other  hand,  active  work  in  the  open  sunlight  at  a  tem- 
perature exceeding  100°  is  perilous  for  the  white  man ;  the  colored 
man  endures  it  better,  although,  on  the  other  hand,  he  is  less  resist- 
ant to  the  effects  of  extreme  artificial  heat. 

Of  the  nature  of  the  chemical  action  of  sun-rays  upon  man  but 
little  definite  is  known.  It  is  apparently  directly  proportional  to 
luminosity,  but  also  greatly  influenced  by  heat ;  in  fact  it  is'  seldom 
noticeable  except  when  accompanied  by  a  high  degree  of  heat,  so 
that  only  in  warm  countries  does  it  become  sufficiently  marked  to  be 
injurious.  On  the  summit  of  high  mountains,  solar  radiation  and 


696  MILITARY    HYGIENE. 

luminosity  are  greater  (see  p.  517),  and  the  intensity  of  chemical 
action  is  said  to  be  much  increased  {Hann}  ;  but,  provided  the  head 
be  kept  well  protected,  the  cold  air  and  perhaps  also  the  active 
evaporation  from  the  skin  prevent  any  dangerous  effect  of  insolation. 

It  is  to  the  constant  stimulus  of  sunlight  that  are  attributed  the 
quick  fancy,  vivacity  of  gesture  and  animated  language  of  the  people 
of  southern  countries.  But  light,  like  heat,  is  often  excessive  and 
must  be  guarded  against.  A  strong  light  reflected  from  a  white 
bright  surface  soon  becomes  painful  and,  if  continued,  may  produce 
headache,  blurred  vision  and  vertigo ;  in  other  words,  a  lightstroke. 

According  to  some  writers,  the  stimulating  effect  of  sunlight  is  due 
to  its  actinic  rays ;  pleasant  and  helpful  when  moderate,  but  harm- 
ful, depressing  and  overwhelming  when  excessive.  The  well-known 
disinfecting  effect  of  sunlight,  that  is,  its  destructive  action  upon 
pathogenic  bacteria,  the  decomposition  of  the  atmospheric  carbon 
dioxid  under  its  influence  by  plants  containing  chlorophyll,  its  effect 
in  tanning,  inflaming  and  blistering  the  human  skin,  in  blackening 
silver  salts  in  photographic  films,  as  well  as  in  the  process  of  bleach- 
ing fabrics,  are  so  many  instances  of  chemical  action.  The  strong 
disinfecting  power  of  the  ultra-violet  rays  is  utilized  in  the  purifica- 
tion of  water  (p'age  282).  The  decomposition  of  a  solution  of 
oxalic  acid  under  the  influence  of  uranyl  acetate  (as  catalyser)  only 
occurs  through  the  action  of  the  ultra-violet  rays.  Bacon  found 
that  this  decomposition  in  Manila,  in  July,  was  from  5  to  20  times 
greater  than  in  Chicago,  in  June. 

Effects  of  actinic  or  chemical  rays  upon  man.  —  The  effects  of 
the  actinic  rays  upon  the  health  and  efficiency  of  man,  especially  of 
the  white  man,  is  a  question  upon  which  much  light  has  recently  been 
shed.  The  majority  of  the  races  of  mankind  have  pigmented  skins 
ranging  through  various  combinations  of  brown,  red  and  yellow.  It 
has  been  naturally  inferred  that  the  purpose  and  function  of  this 
cutaneous  pigment  is  to  exclude  the  actinic  rays  of  the  sun.  This 
inference  suggested  to  the  white  man,  in  warm  climates,  to  protect 
himself  in  a  similar  manner  by  lining  his  hat  and  coat  with  a  fabric 
of  the  color  that  best  excludes  the  objectionable  rays.  It  is  well 
known  that  white  men  are  occasionally  seen  who  are  unable  to  re- 
main exposed  to  the  sun  without  acute  headache  and  great  discom- 
fort until  they  have  recourse  to  this  simple  expedient. 

What  color  is  most  effective  to  that  end?    Which  shade  of  human 


SERVICE   IN    WARM    CLIMATES.  697 

pigment  should  we  approximate?  The  copper  of  the  American 
Indian,  the  bronze  of  the  Hindoo,  the  yellow  of  the  Chinese  or  the 
black  of  the  negro  ?  It  appears  that  the  nearer  we  approach  to  the 
equator  the  darker  becomes  the  pigment,  and  that  black,  therefore, 
should  be  preferred.  It  is  known  that  red  and  orange  keep  out  more 
of  the  actinic  rays  than  any  other  color  of  the  solar  spectrum  and, 
for  that  reason,  are  used  by  photographers  in  the  windows  of  their 
dark  rooms.  In  following  out  this  indication,  undue  prominence  has 
been  given  these  two  colors  by  tropical  hygienists,  while  the  claim  of 
the  plain  black,  which  for  obvious  reasons  cannot  be  used  by  photog- 
raphers, has  been  overlooked.  If  small  squares  of  silk,  of  exactly 
the  same  texture  and  thickness  but  of  the  different  colors  of  the 
spectrum  (as  near  as  they  can  be  approximated  in  dry-goods  stores), 
with  black  and  white  added,  are  placed  on  very  sensitive  photographic 
bromide  paper  and  exposed  an  instant  to  the  light,  it  will  be  found 
(Fig.  231)  that  black  excludes  the  chemical  rays  more  completely 
than  any  color,  and  that  the  colors  exclude  them  in  the  following 
order :  red,  orange,  green,  blue,  indigo,  violet,  yellow,  white.  In 
studying  Fig.  231,  it  is  interesting  to  note  the  selvage  edge  which,  in 
all  the  samples,  is  on  the  right  side.  This  edge  is  not  appreciably 
thicker  than  other  parts  of  the  fabric  but  more  closely  woven,  there- 
fore more  opaque.  The  result  is  seen  in  the  fact  that  this  edge  is 
white,  or  nearly  so,  in  all  the  colors  except  yellow,  violet  and  white. 
The  effect  of  color,  however,  is  obvious  in  the  selvage  of  the  black 
and  blue  squares  where  a  white  line  becomes  black,  and  in  that  of 
the  yellow  square  where  a  reddish  line  becomes  nearly  white. 

From  these  and  similar  observations,  it  is  deduced  that  the  non- 
actinic  value  of  a  textile  fabric  depends  more  or  less  upon  its  color, 
but  more  upon  its  opacity ;  that  any  fabric  which  excludes  light  also 
shuts  out  actinic  rays,  and  that  this  result  is  most  surely  and  easily 
obtained,  the  thickness  of  the  cloth  remaining  the  same,  with  black 
than  red  or  orange ;  black  is  also  more  easily  procured  and  less  con- 
spicuous ;  therefore  it  should  be  the  color  of  the  fabric  used  tO'  line 
the  head-dress  and  part  of  the  coat,  or  for  the  undershirt.  Silk 
being  light  and  a  poor  heat  conductor  may  be  particularly  recom- 
mended as  the  best  material  for  the  purpose  (see  p.  424). 

This  question  seemed  of  sufficient  importance  to  the  War  Depart- 
ment to  warrant  the  undertaking  of  experiments  on  a  large  scale  to 
ascertain  the  real  value  of  anti-actinic  clothing.  These  experiments 


698 


MILITARY    HYGIENE. 


were  continued  for  over  one  year,  in  the  Philippines,  and  fully  re- 
ported upon  in  1910  by  Phalen,  of  the  Medical  Corps.  Five  hundred 
men  were  supplied  with  orange-red  underwear  (shirt  and  drawers) 
and  hat  lining;  500  other  men  wearing  ordinary  white  underwear 
were  selected  as  controls.  Both  kinds  of  underwear  were  practically 
identical  in  material  and  weight.  The  men  wearing  the  special  cloth- 
ing and  the  controls  were  taken  from  the  same  companies,  the  two 
groups  being  as  nearly  as  possible  equal  in  physique  and  assigned  to 
the  same  duties.  It  was  found  that  in  the  special  group,  as  com- 


FIG.  231. —  Photograph  showing  the  anti-actinic  value  of 
colors,  including  white  and  black. 


SERVICE    IN    WARM    CLIMATES.  699 

pared  with  the  controls,  the  loss  of  weight  was  greater;  that  the 
rates  of  temperature,  pulse  and  respiration  were  slightly  higher; 
that  the  loss  of  blood  pressure  was  greater ;  that  the  blood  changes 
(increase  of  red-cells  and  loss  of  hemoglobin)  were  more  pro- 
nounced. The  general  health  condition,  as  estimated  from  the  ad- 
missions to  the  sick  report,  was  practically  the  same  in  both  groups. 
The  great  majority  of  the  wearers  of  colored  under-garments,  that 
is,  4  out  of  every  5,  pronounced  them  distinctly  less  comfortable 
than  white  ones. 

Although  the  differences  noted  above  are  but  slight  they  justify 
the  conclusion,  when  considered  collectively,  that  colored  under- 
garments are  more  absorptive  of  heat  rays  than  white  ones.  This 
was  directly  proved  by  many  experiments  both  on  and  off  the  body, 
showing  that,  when  exposed  to  the  sun,  the  temperature  was  greater 
beneath  the  orange-red  material  than  beneath  similar  white  material. 
Thus  of  two  flasks  covered,  one  with  orange-red,  and  the  other  with 
white  material,  after  one  hour's  exposure,  the  first  showed  a  tem- 
perature of  48.2°  C.  and  the  other  44°.  In  the  case  of  a  man  wear- 
ing a  composite  shirt,  half  white  and  half  orange-red,  it  was  found, 
after  10  minutes'  exposure,  that  the  thermometer  beneath  the  white 
side  registered  37-75°  C.  and  the  one  beneath  the  colored  side  43°. 
The  same  results  followed  when  both  materials  were  overlaid  with 
khaki  cloth,  although  the  difference  was  not  so  marked. 

It  must  be  conceded  that  orange-red  underclothing  protects  the 
body  from  the  actinic  rays  of  the  sun,  at  least  from  those  rays  that 
act  upon  photographic  plates.  This  protection,  however,  does  not 
only  depend  upon  the  color  of  the  fabric  but  also  upon  its  thickness 
and  the  tightness  of  its  weave,  that  is,  upon  its  opacity.  It  was 
found  that  the  campaign  hat  is  as  opaque  to  chemical  rays  without  a 
red  lining  as  with  it,  while  this  lining  added  materially  to  the  opacity 
and  anti-actinic  power  of  the  khaki  cap.  The  greater  thickness  and 
tighter  weave  of  the  American  khaki,  as  compared  with  English 
khaki,  render  it  more  protective.  The  blue  and  olive-drab  flannel 
shirts  were  shown  to  be  not  nearly  so  protective  as  had  been  ex- 
pected. 

We  may  conclude  that,  if  underclothing  of  undoubted  anti-actinic 
power  has  no  favorable  effect  upon  the  vitality  and  efficiency  of  the 
white  men  wearing  it,  it  is  because  the  chemical  rays  of  the  sun, 
under  ordinary  circumstances,  really  play  an  unimportant  part  as  a 


JOG  MILITARY    HYGIENE. 

climatic  factor  and  are,  so  far  as  the  great  majority  of  men  are  con- 
cerned, a  negligible  quantity.  It  is  possible,  however,  that  under  a 
blazing  sun  and  with  inadequate  protection,  the  actinic  rays  may 
acquire  dangerous  power ;  thus  might  some  of  the  symptoms  of  ful- 
minant insolation  be  accounted  for.  It  is  also  known  that,  occasion- 
ally, men  are  found  who  are  especially  susceptible  and  need  to  be 
guarded  against  their  influence.  Thus  of  the  500  subjects  of  the 
experiment  noted  above,  7  preferred  the  colored  underwear  because 
it  relieved  them  of  "  headache  and  dizziness  "  (in  4),  of  "  headache" 
(in  i),  of  "  fever"  (in  i)  and  of  "prickly  heat"  (in  i).  Of  the 
few  officers  who  also  tried  it,  one  stated  that  he  had  been  entirely 
relieved  from  "  a  feeling  of  depression  of  spirits  and  irritation  " 
which  previously  always  followed  exposure  to  the  sun.  For  this 
small  percentage  of  men,  colored  or  black  underwear  and  hat  lining 
will  always  be  desirable  and  should  be  provided. 

That  the  skin  pigment  has  some  protective  action  against  chemical 
rays  must  be  conceded,  but  there  is-  nothing  to  prove  that  this  action 
possesses  physiological  importance ;  otherwise,  how  to  explain  the 
various  colorings  of  this  pigment  in  different  races  subjected  to  prac- 
tically the  same  climatic  influences,  and  why  should  people  living  in 
northern  latitudes,  like  the  Esquimos,  North  American  Indians  and 
Chinese,  have  so  much  of  it  ?  We  also  know  that  races  greatly  dif- 
fering in  kind  and  degree  of  pigmentation  have  lived  together  for 
centuries  in  the  same  regions  (as  in  Egypt)  without  any  tendency  to 
an  approximation  of  pigmentary  hue.  It  seems  more  probable  that 
pigmentation  is  one  of  the  racial  characteristics,  acquired  ages  ago, 
and  that  it  is  no  more  the  direct  effect  of  the  sun  than  is  the  shape 
of  the  nose,  the  thickness  of  the  lips  or  the  projection  of  the  cheeks. 

Some  of  the  experiments  reported  by  Phalen  bear  on  this  subject. 
Specimens  of  human  skins  of  different  hues,  made  as  nearly  as  pos- 
sible of  uniform  thickness,  were  tested  with  photographic  plates  to 
ascertain  the  extent  of  their  opacity  to  the  chemical  rays.  Compar- 
ing a  very  dark  Filipino  skin  with  a  white  one,  there  was,  as  ex- 
pected, a  notable  difference,  but  only  for  short  exposure ;  by  in- 
creasing the  exposure  to  one  minute  the  effects  on  the  photographic 
plates  did  not  differ  very  greatly.  A  comparison  of  the  effect  pro- 
duced through  the  light  brown  and  white  skins  showed  practically  no 
difference.  It  was  noted  that  the  texture  of  the  former  was  much 
softer  than  that  of  the  latter.  On  a  photograph  made  by  short 


SERVICE    IN    WARM    CLIMATES.  7OI 

exposure  through  the  darkest  skin,  and  through  the  white  skin  rein- 
forced by  one  layer  of  khaki  cloth,  it  was  observed  that  the  latter 
fabric  completely  neutralized  the  difference  in  opacity  existing  be- 
tween the  skins.  Another  fact  was  shown,  namely,  that  the  pigment 
of  the  darkest  skin  does  not  by  any  means  approximate  the  orange- 
red  of  the  experimental  garments  in  excluding  the  chemical  rays. 
The  abundant  blood  circulating  in  the  deeper  layers  of  the  skin,  says 
Phalen,  is  probably  much  more  efficient  as  a  protection  against  the 
chemical  ray  than  is  the  layer  of  pigment. 

Black  pigment  seems  to  be  of  much  greater  use  in  mitigating  the 
heat  rays  than  in  intercepting  the  chemical  rays.  As  is  well  known, 
black  absorbs  more  solar  heat  than  any  color,  but  also  radiates  most. 
Thus  hot  tea  poured  in  a  black  pot  will  cool  more  rapidly  in  the  shade 
than  if  put  in  a  light-colored  vessel.  A  dark-hued  skin,  therefore, 
loses  heat  more  quickly  than  a  white  skin  at  night  or  whenever  pro- 
tected from  the  sun.  But  when  exposed  to  the  sun,  another  physio- 
logical process  comes  into  play  which  again  gives  it  the  advantage, 
as  shown  by  Aron  in  the  Philippines.  Being  more  quickly  heated, 
the  temperature  at  which  the  sweat  starts  is  mone  promptly  reached 
and,  with  the  sweat,  comes  evaporation  and  cooling  of  the  surface. 
The  regulatory  apparatus  of  the  dark  skin,  with  its  abundant  sweat 
glands,  is  more  sensitive  than  that  of  the  light  skin  and  responds 
more  promptly  and  successfully  to  the  stimulus  of  heat;  accord- 
ingly Aron  found  that,  in  the  sun,  the  white  skin  is  always  slightly 
hotter  than  the  brown  skin.  How  much  of  this  effect  is  due  to 
.color,  to  the  innervation  of  the  sweat  glands,  or  the  number  and 
structure  of  the  latter  is  not  yet  clearly  determined.  The  white  man 
is  more  likely  to  perspire  profusely,  with  dripping  sweat,  a  condition 
which  weakens  the  body  from  loss  of  water  without  corresponding 
cooling  effect,  the  comparatively  thick  sweat  layer  absorbing  more 
heat  from  the  air  than  from  the  skin  in  the  process  of  evaporation. 
In  the  brown  man,  on  the  contrary,  the  perspiration,  although  very 
free,  is  spread  in  a  thinner  film  over  the  skin,  seldom  in  excess  of 
what  can  be  evaporated,  while  the  evaporation  is  more  completely  at 
the  expense  of  the  body  temperature. 

An  interesting  question  is  the  relative  ability  of  blonds  and 
brunettes  to  withstand  tropical  conditions.  It  has  been  contended  by 
most  writers  that  the  latter  were  better  fitted  by  nature  to  resist  the 
detrimental  influences  of  warm  countries.  This  subject  having  been 


7O2  MILITARY    HYGIENE. 

elaborately  investigated  by  a  medical  board,  its  president,  Major 
Chamberlain,  reported  that :  "  From  a  consideration  of  all  the  data 
it  appears  that,  among  American  soldiers,  blonds  are  quite  as  well 
able  as  brunettes  to  withstand  the  influences  of  the  Philippine  climate 
for  a  period  of  two  years  and  probably  for  a  period  of  five  and  one- 
half  years,"  the  time  covered  by  the  investigations.  Among  the  two 
groups  there  was  the  same  relative  amount  of  sickness,  the  same 
proportion  invalided  home  and  discharged,  and  the  same  influence 
on  character  and  behavior. 

The  intense  luminosity  or  glare  of  hot  climates  is  often  distress- 
ing to  the  eye,  and  should  be  .mitigated  so  far  as  practicable ;  the 
brim  of  the  hat  or  helmet,  or  the  visor  of  the  cap,  should  be  wide 
enough  to  afford  adequate  protection.  Colored  glasses  are  often 
useful.  Gould  thinks  that  amber-colored  .glasses  are  best,  admitting 
enough  of  the  more  luminous  rays  (yellow)  and  excluding  those 
which  are  injurious  to  the  retina. 

Sunstroke. 

Under  this  comprehensive  popular  name  are  included  three  separ- 
able conditions,  although  the  first  two  are  not"  always  clearly  differ- 
entiated :  insolation,  heat-stroke  and  heat  exhaustion,  and  the  soldier 
may  suffer  from  one  or  another,  or  a  combination  of  them. 

Insolation  (siriasis,  sunstroke  proper),  the  most  dangerous  of 
them,  results  from  exposure  to  the  direct  rays  of  the  sun  .at  a  high 
temperature.  It  has  been  ascribed  to  the  action  of  the  «ultra-violet 
or  actinic  rays  of  sunlight  but  this  contention  hasrnot  been  confirmed 
by  more  recent  investigations.  Whatever  influences  these  rays  may 
exert,  it  seems  pretty  well  established  that  siriasis  is  chiefly  the 
result  of  a  rapid  and  excessive  increase  of  body  temperature,  and 
it  appears  probable  that  the  immediate  cause  of  such  dangerous  in- 
crease is  the  stoppage  of  perspiration  brought  about  by  a  disturb- 
ance in  the  cutaneous  innervation.  It  is  not  unlikely,  however,  that 
the  actinic  rays  are  responsible  for  this  disturbance  of  innervation, 
as  they  are  in  the  production  'of  sunburn.  Thus  would  be  explained 
the  fact  that  the  degree  of  temperature  which  in  sunlight  causes 
sunstroke  is  harmless  in  the  engine-room  of  a  steamer. 

•  Insolation  is  always  manifested  by  rapid  and  severe  symptoms, 
such  as  intense  headache,  a  quick,  full  pulse  and  hot,  dry  skin,  sug- 
gesting meningeal  congestion  or  inflammation ;  or,  in  grave  cases,  by 


SERVICE    IN    WARM    CLIMATES.  703 

sudden  unconsciousness  from  paralysis  of  the  heart  or  of  respiration, 
the  result  of  hemorrhages  in  the  brain  and  meninges.  It  may  be  seen 
on  the  march  but  is  more  likely  to  occur  during  the  stress  of  battle, 
under  a  blazing  sun,  when  the  head  is  imperfectly  protected. 

Heat-stroke,  also  called  thermic  fever,  is  of  common  occurrence 
in  this  country  wherever  great  heat  and  a  high  degree  of  humidity 
are  combined,  as  in  the  eastern  and  southern  States.  Intemperance, 
in  eating  as  well  as  in  drinking,  fatigue,  bad  ventilation,  malaria 
and  all  other  depressing  conditions  are  predisposing  influences.  Its 
etiology  is  still  uncertain ;  heat  is  probably  the  chief  factor,  with 
more  or  less  actinic  effect.  From  the  fact  that  direct  exposure  to 
the  sun  is  not  necessary  for  its  production,  and  the  peculiarities  of 
its  distribution  and  prevalence,  Sambon  and  Manson  are  inclined 
to  consider  it  a  germ  disease,  a  view  not  generally  accepted.  The 
symptoms  are,  in  the  first  stage :  fatigue,  pains  in  the  limbs,  drowsi- 
ness, headache,  vertigo,  mental  confusion,  intolerance  of  light,  con- 
tracted pupils,  suffused  eyes  and  face,  nausea  and  vomiting,  hot,  dry 
skin  (rarely  moist)  and  quick  pulse.  They  are  soon  succeeded  by 
high  fever  and  burning  skin,  the  temperature  rising  to  108°  to  109° 
F.  (H.  C.  Wood),  an  exceedingly  rapid  pulse,  later  becoming  irregu- 
lar and  intermittent,  labored  breathing,  convulsions  and  complete 
unconsciousness.  In  mild  cases,  the  symptoms  may  be  limited  to 
some  febrile  movement,  disturbance  of  the  digestive  functions  and 
torpidity  of  bowels.  The  treatment  consists  in  taking  the  patient 
to  a  cool,  shady,  well-ventilated  place,  removing  his  clothing  and  re- 
ducing his  temperature  by  cold  baths.  Hot  baths  have  also  been 
highly  recommended.  The  administration  of  digitalis  and  strych- 
nine will  generally  be  indicated,  and  artificial  respiration  may  be 
necessary. 

It  must  be  borne  in  mind  that  some  of  the  pathological  effects  of 
sunstroke  are  more  or  less  permanent,  that  the  patient  seldom  com- 
pletely recovers  and  always  remains  more  susceptible  to  a  subse- 
quent attack;  hence  the  saying,  in  some  of  the  British  colonies,  that 
"  once  sunstruck  always  sunstruck."  It  seems  an  admitted  fact 
that  man  does  not  become  habituated  to  hot  solar  rays,  so  as  to  be 
immune  to  their  effects,  any  more  than  he  becomes  habituated  to 
the  contact  of  fire.  The  native  of  hot  countries,  although  endowed 
by  nature  with  a  dense  and  very  black  (non-actinic)  head  of  hair, 
generally  protects  himself  with  ample  hat  or  thick  turban.  The 


704  MILITARY    HYGIENE. 

present  custom  or  fashion  of  riding  and  indulging  in  all  sorts  of 
outdoor  sports,  bare-headed,  during  the  hot  summer  days,  is  not 
approved  by  the  best  judgment  of  hygienists  and  may  certainly 
result  in  serious  harm.  It  is  known  to  have  produced  alopecia. 

Heat-exhaustion  is  a  state  of  syncope  or  faintness  resulting  from 
high  atmospheric  temperature  combined  with  fatigue  or  privation, 
and  often  induced  by  alcoholic  excess.  The  patient  is  pale,  with 
cold  skin  and  subnormal  temperature;  the  pulse  is  small  and  soft, 
and  the  breathing  shallow ;  the  pupils  are  generally  dilated.  There 
is  seldom  complete  unconsciousness.  He  should  be  laid  on  his  back 
in  a  cool,  shady  place,  his  clothing  loosened  and  a  little  water  dashed 
on  his  face  and  chest.  Gentle  stimulation  is  indicated ;  spirits  of 
ammonia  may  be  held  to  the  nose  or  given  by  the  mouth ;  whiskey, 
suitably  diluted,  may  likewise  be  given  by  the  mouth  or  else,  in 
case  of  unconsciousness,  injected  into  the  rectum. 

CLOTHING. 

The  general  subject  of  clothing  has  already  been  considered,  and 
so  far  as  it  relates  to  the  tropics  can  be  summed  up  in  a  few  words. 

For  underclothing,  flannel,  even  of  light  material,  is  seldom  com- 
fortable. It  should  preferably  consist  of  a  cotton-knit  loose  under- 
shirt with  short  sleeves,  jean  or  muslin  drawers  not  coming  much 
below  the  knees,  and  cotton  socks.  For  those  who  can  afford  it, 
a  gauze  of  wool  and  silk  makes  the  ideal  material  for  underwear. 
The  so-called  linen-meshed  garments  are  also  very  satisfactory  and 
preferred  by  many.  Care  must  be  taken  that  the  material  is  never 
so  thin  and  porous  as  to  allow  the  body  to  become  chilled  in  the 
evening. 

When  the  coat  is  not  worn,  the  olive-drab  flannel  shirt  is  substi- 
tuted. The  best  head-gear  is  a  well-constructed,  black-lined  helmet ; 
but,  for  the  field,  the  campaign  hat  is  more  serviceable,  provided  it 
is  sufficiently  thick,  well  ventilated  and  water-proof.  With  suitable 
head-gear  it  is  best  to  keep  the  hair  cut  short. 

A  flannel  abdominal  band  or  apron  (see  page  440),  worn  at  night, 
is  often  serviceable  in  the  tropics,  especially  in  the  hot  season.  As 
one  lies  in  bed,  uncovered  and  perspiring,  the  abdomen,  which  is 
the  most  sensitive  part  of  the  body,  will  be  chilled  before  any  other 
part ;  the  bowels  lie  so  near  the  wall  of  the  abdomen  that  their  cir- 
culation is  easily  deranged  by  changes  of  temperature,  and  digestive 


SERVICE    IN    WARM    CLIMATES.  705 

or  intestinal  troubles  may  result  in  susceptible  people.  The  ab- 
dominal band  is  never  useful  during  the  day,  and  seldom  at  night 
when  the  cold  is  so  marked  as  to  require  one  or  two  blankets  over 
the  sleeper. 

SHELTER. 

In  the  erection  of  quarters  or  barracks  in  the  tropics,  the  objects 
to  be  aimed  at,  from  the  hygienic  viewpoint,  are  to  exclude  heat 
and  excessive  light,  and  provide  ample  ventilation.  Greater  air 
space  and  movement  should  be  provided  than  in  northern  climates, 
and  this  can  be  done  chiefly  by  raising  the  ceiling  to  a  height  of  13 
or  14  feet  and  extending  the  windows  downward  to  near  the  floor 
and  upward  to  near  the  ceiling.  The  barracks,  and  as  many  of  the 
other  buildings  as  possible,  should  be  so  oriented  as  to  face  north, 
therefore  with  the  long  axis  running  east  and  west.  This,  however, 


FIG.  232. —  U.   S.  barrack  in  the  tropics.     (Honolulu.) 

may  be  modified  in  accordance  with  prevailing  breezes ;  thus  to  get 
the  benefit  of  the  N.  E.  trade-winds,  the  axis  should  preferably  run 
N.  W.  to  S.  E.  The  barracks  should  be  of  two  stories,  each 
story  with  a  broad  veranda  going  all  around  and  protected  by  Vene- 
tian blinds  on  the  sunny  sides.  The  upper  story  is  to  be  used  for 
dormitories,  and  above  it  should  be  a  spacious,  well-ventilated  attic. 
The  best  building  material  is  iron,  brick  and  stone;  a  thick  wall 
with  a  course  of  perforated  bricks  permitting  a  free  air  circulation 
is  nearly  ideal.  The  roof  should  be  of  tile  or  concrete,  and  the 
floors  of  cement,  vitrified  brick  or  tile.  The  color  of  the  outside 
paint  or  kalsomining  must  not  be  white,  which  injuriously  dazzles 
the  eye,  but  a  soft  light  tint  of  gray,  yellow,  pink  or  blue. 

In  India,  according  to  Melville,  the  2-story  barrack  has  not  been 
found  very  satisfactory.     In  its  stead  are  preferred  half-company 


706 


MILITARY    HYGIENE. 


bungalows  with  simple  verandas,  each  bungalow  consisting  of  two 
dormitories,  20  feet  high,  in  which  1,800  cubic  feet  of  air  are  allowed 
per  man.  Between  these  dormitories  a  mess-room  and  kitchen  are 
provided. 

The  effect  of  water  evaporation  in  cooling  the  air  of  habitations 
is  seldom  fully  appreciated  and  utilized;  thus  the  temperature  of 
a  room  70  feet  long  by  30  feet  wide,  sprayed  with  a  gallon  of  water, 
will  speedily  fall  from  80°  to  70°  F.  Verandas  should  be  freely 
sprinkled.  The  East  Indian  method  of  suspending  mats  in  door- 
ways on  the  windward  side,  and  keeping  them  constantly  wet  is  also 
very  efficient,  provided  there  is  a  breeze.  The  methods  employed 
in  cold-storage  rooms,  especially  the  ammonia  process,  are  also 
applicable,  on  a  smaller  scale,  to  all  other  kinds  of  buildings. 
Where  artificial  ventilation  is  used,  the  air  can  be  driven  through 
an  ice  chamber  before  its  distribution.  Simpler  economic  devices 


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SERVICE   IN    WARM    CLIMATES.  707 

have  been  recommended,  such  as  that  of  Moore  in  which  the  air 
passes  down  a  cylinder  filled  with  cracked  ice  and  salt,  and  that  of 
Gates  in  which  the  air  is  purified  and  cooled  by  water  spray.*  Dr. 
Manning,  of  Washington,  D.  C,  suspends  horizontally  a  strip  of 
cotton  twill,  three  feet  wide  and  as  long  as  desired,  in  the  room  to 
be  cooled,  and  keeps  it  saturated  with  water  by  means  of  a  per- 
forated pipe  passed  through  a  hem  in  the  upper  edge,  the  water 
being  collected  below  in  a  trough  hanging  from  the  lower  edge. 
With  an  electric  fan  playing  upon  one  end  of  it,  a  wavy,  serpentine 
motion  can  be  imparted  to  the  entire  strip  and  the  evaporation 
greatly  increased. f 

The  mosquito  being  always  a  dangerous  enemy  in  warm  countries, 
every  effort  must  be  made  to  exclude  it;  in  a  malarial  locality  all 
quarters  should  be  completely  screened,  and  originally  planned  with 
a  view  to  the  possibility  of  this  effective  screening.  But,  under  all 
circumstances,  at  least  the  kitchen  and  mess-room  should  be  entirely 
protected  by  wire  netting,  so  as  to  keep  out  not  only  mosquitoes  but 
also  flies  and  other  insects. 

In  cantonments,  i-story  frame  buildings  well  raised  above  the 
ground,  with  suitable  verandas,  large  windows,  ridge  ventilation  and 
tiled  roof  (or  double  roof  of  corrugated  iron)  are  very  satisfactory, 
but  it  will  often  be  found  advantageous  to  utilize  native  material 
and  labor  and  erect  structures  of  bamboo  and  thatch  which  can  be 
made  fairly  comfortable  and  sanitary. 

The  use  of  tents,  in  warm  climates,  should  be  avoided  as  much 
as  possible,  as  it  is  always  difficult  to  keep  them  reasonably  cool, 
dry  and  otherwise  comfortable.  Whenever  used,  each  should  be 
covered  with  its  fly  set  at  an  interval  of  about  a  foot  from  the  roof. 
In  a  camp  of  some  duration,  the  tents  should  be  shaded,  whenever 
possible,  with  a  roof  of  brush,  straw  or  grass.  An  excellent  method 
of  cooling  them  is  to  dash  water  against  the  walls  and  over  the  roof, 
but  not  enough  to  close  the  pores  of  the  canvas.  The  best  tents 
for  hot  weather  are  the  tropical  hospital  tent  and  the  tropical  wall 
tent  described  under  Camps  (page  620).  For  the  sick,  a  black,  dark 
blue  or  dark  red  lining,  to  exclude  actinic  rays,  will  add  to  the  com- 
fort of  the  hospital  tent ;  if  more  light  is  desired  this  lining  can  be 
covered  with  pale  yellow  chintz.  The  conical  tent  is  entirely  unfitted 

*  See  Sergey's  Principles  of  Hygiene. 
t  /.  A.  M.  A.,  June  4,  1910. 


708  MILITARY    HYGIENE. 

for  hot  countries ;  it  is  more  stable  but,  on  account  of  the  low  roof 
and  lack  of  fly,  always  several  degrees  warmer  than  the  hospital  tent. 

GENERAL  DIRECTIONS. 

Physical  exercise,  in  the  tropics,  is  highly  useful  and  should  never 
be  neglected,  but  must  be  performed  at  the  proper  time.  Drills  and 
all  military  exercises  should  not  be  permitted,  as  a  rule,  whenever 
the  temperature  exceeds  85°  F. ;  with  a  cooling  breeze  this  limit 
might  be  raised  to  90°  ;  therefore  the  best  time  for  them  will  be  in 
the  early  morning  before  8  o'clock,  or  in  the  evening  after  5  o'clock. 
All  work  not  absolutely  necessary  should  be  suspended  between  n 
A.  M.  and  4  P.  M.,  the  hours  of  siesta.  During  these  hours  it  is  not 
necessary  that  the  men  should  sleep,  but  desirable  that  they  should 
enjoy  complete  mental  and  physical  relaxation.  Marching  should 
begin  at  dawn,  or  even  before,  and  stop  at  or  before  9  o'clock,  to 
be  resumed,  if  necessary,  after  5  p.  M.  To  break  the  usual  night 
rest  is  always  to  be  deprecated  but,  whenever  optional,  it  is. less 
exhausting  and  greatly  preferable  to  do  so  than  to  march  during 
the  day  under  a  torrid  sun,  provided  time  is  given  to  make  up  sleep 
at  the  first  opportunity.  There  is  a  time  of  day  when  the  sun  is 
exceedingly  trying,  that  is  when  approaching  the  horizon,  before 
setting ;  then  its  horizontal  rays  strike  the  face,  eyes  and  temples, 
parts  well  protected  at  other  times,  with  great  actinic  intensity.  If 
the  command  is  not  yet  in  camp,  and  the  direction  of  the  march  is 
westward,  it  will  be  wise,  circumstances  permitting,  to  halt  until  after 
sunset.  The  step  should  be  an  easy  route  step,  in  open  order  and 
with  load  as  light  as  possible.  The  men  should  seldom  drink  on  the 
march,  except  at  the  halts,  after  cooling  off,  and  then  moderately. 

With  proper  care,  even  large  bodies  of  troops  can  march  in  sum- 
mer over  extensive  desert  tracts,  in  tropical  countries,  without 
serious  losses.  Such  is  the  march  described  by  Dr.  James  Mc- 
Gregor, of  an  English  army  from  India,  which  disembarked  at 
Kosseir  on  the  Red  Sea,  in  June,  1801 ;  by  marching  always  at  night 
it  reached  the  banks  of  the  lower  Nile  (over  400  miles)  in  a  month, 
in  "  a  very  healthy  state,"  in  spite  of  the  intense  heat,  dust  and  hot 
winds,  and  of  uncomfortable  garments  with  much  neck  gear  and 
strapping. 

In  warm  countries  the  loss  of  heat  by  radiation  is  generally  very 
rapid  after  sunset,  causing  a  sudden  fall  of  temperature  and  chilling 


SERVICE    IN    WARM    CLIMATES.  709 

sensation.  The  same  sudden  change  may  take  place  after  a  rain. 
This  is  to  be  guarded  against  by  buttoning  up  the  shirt  and  blouse, 
adding  or  changing  garments,  especially  by  those  susceptible  to 
malarial  or  diarrheal  diseases.  The  experienced  soldier  never  parts 
with  his  blanket,  however  irksome  it  may  be  to  carry  during  the 
day.  The  effect  of  altitude  on  the  tropical  climate  is  also  very  re- 
markable, a  rise  of  1,000  feet  being  equivalent  to  a  change  of  6° 
to  10°  latitude  further  north,  while  the  noctural  temperature  falls 
still  in  a  greater  ratio.  Thus  while  the  heat  is  intolerable  in  Santiago 
de  Cuba,  in  June  and  July,  Cristo,  a  few  miles  away,  at  an  altitude 
of  only  800  feet,  is  delightfully  cool.  This  fact  should  be  taken 
advantage  of  in  locating  barracks  and  hospitals  ;  even  an  elevation  of 
100  or  200  feet  is  decidedly  advantageous. 

The  principle  that  soldiers  in  camp  should  never  sleep  on  the 
ground  applies  especially  to  tropical  countries.  If  cots  are  not  avail- 
able, the  poncho  or  slicker  should  be  interposed  between  the  ground 
and  the  blanket  or  overcoat  used  as  bedding;  but  still  better,  if  time 
permits,  a  bedstead  should  be  improvised.  The  mosquito-bar  is 
never  to  be  dispensed  with,  except  by  authority,  when  the  complete 
absence  of  mosquitoes  has  been  ascertained. 

The  cold  bath  in  hot  countries  is  certainly  an  excellent  means  to 
combat  the  heat  and  prevent  the  loss  of  nervous  energy.  The  swim 
at  the  beach  or  the  shower-bath  at  the  barracks  cannot  be  too  highly 
recommended,  provided  it  is  short  and  no  depressing  effect  is 
produced. 

To  observe  the  state  of  his  bowels  and  regulate  them  as  required 
should  be  one  of  the  important  hygienic  cares  of  the  soldier  in  the 
tropics.  The  waste  products  from  excessive  proteid  alimentation, 
the  sluggish  digestion  and  rapidity  of  bacteria  multiplication  greatly 
increase  the  danger  of  auto-infection.  Many  cases  of  "  unde- 
termined "  fever  are  doubtless  the  result  of  the  reabsorption  of  toxic 
products  from  the  intestinal  canal.  The  heat  (and  solar  actinic 
rays)  so  affect  the  nervous  system  as  to  often  check  the  neristaltic 
motion  of  the  bowels,  with  consequent  constipation.  This  should 
be  overcome  by  cold  shower-baths,  massage  and  vegetable  and 
fruit  diet. 


7IO  MILITARY    HYGIENE. 

TROPICAL   DISEASES. 

(See  also  page  15.) 

As  has  been  stated  before,  constant  high  temperature  and 
humidity  are  favorable  to  the  multiplication  of  microbes,  as  well 
as  that  of  insect  life  and  vermin,  and  this  explains  the  rapid  decom- 
position and  decay  of  organic  matter  in  the  tropics,  with  or  without 
putrefactive  odors.  These  microbes,  however,  are  practically  all 
saprophytes  and  harmless  to  man.  As  to  pathogenic  germs,  the  con- 
ditions under  which  they  breed  and  are  transmitted  are  now  well 
understood,  with  the  result  that  the  prevalent  infectious  diseases 
which  they  produce  are  all  preventable  and  can  be  stamped  out  by 
the  application  of  well-known  sanitary  measures.  Such  diseases  as 
leprosy,  bubonic  plague  and  cholera  continue  to  lurk  in  some  of  our 
colonies  after  having  disappeared  from  colder  climates,  more  on  ac- 
count of  the  ignorance  and  indifference  of  the  natives  than  because 
of  more  favorable  conditions  for  the  breeding  of  germs.  There 
are,  however,  many  insects,  parasites  and  organisms  only  found  in 
warm  countries,  so  that  the  infections  they  generate,  like  yellow 
fever  and  amebic  dysentery,  do  not  easily  spread  in  temperate  lati- 
tudes ;  but  these  also  are  preventable. 

There  is  no  foundation  for  the  belief  that  tropical  climates  are 
favorable  to  the  development  of  mental  and  nervous  diseases.  The 
reports  of  the  Surgeon  General  for  the  last  decade  show  that  in- 
sanity, neurasthenia  and  suicide  have  not  been  more  common  in  the 
Philippine  Islands  than  in  the  United  States. 

Among  American  soldiers  the  two  classes  of  diseases  by  far  the 
most  prevalent  in  the  Philippines  are  venereal  disorders  and  malarial 
fevers  (see  page  17).  In  1910,  the  ratio  of  the  former  was  nearly 
twice,  and  of  the  latter  over  six  times  that  of  troops  in  the 
United  States.  Venereal  diseases  in  the  Philippines  are  of  a  de- 
cidedly more  contagious  and  virulent  type.  They  have  widely 
spread  since  the  American  intervention  and  many  of  the  interior 
towns  where  they  were  formerly  unknown  have  become  infected. 

There  are  also  indications  that  much  of  the  morbidity  among  our 
troops  in  tropical  territory  is  due  to  excessive  or  improper  diet. 
This  is  shown,  in  the  first  place,  by  the  rates  of  diarrheal  diseases 
which,  in  the  Philippines,  are  more  than  double  those  in  the  United 
States ;  in  the  second  place,  by  the  high  prevalence  of  "  Furuncle 
and  Phlegmon  "  which,  during  the  period  1908-1910,  was  one  of 


SERVICE   IN    WARM    CLIMATES.  Jll 

the  five  diseases  having  the  highest  rates  of  admissions ;  and  in  the 
third  place,  by  the  rather  large  proportion  of  cases  reported  as 
"  undetermined  fevers,"  under  such  headings  as  simple  continued 
fever,  febricula,  ephemeral  fever.  In  1909,  25.46  of  admissions  per 
i, coo  of  strength  were  for  this  class  of  cases  in  the  Philippines, 
against  2.15  in  the  United  States;  in  1910,  the  ratios  were  10.75  and 
2.42  respectively.  Owing  to  the  well-known  care  with  which  diag- 
noses are  made  in  all  suspicious  febrile  cases,  it  seems  probable  that 
many  of  these  undetermined  cases  are  the  result  of  auto-intoxication 
from  excessive  or  inappropriate  proteid  alimentation. 

Dysentery  which,  as  a  cause  of  death,  is  a  negligible  disease  in 
the  United  States  under  normal  conditions,  assumes  much  greater 
importance  in  the  Philippines ;  next  to  tuberculosis  it  had  the  highest 
ratio  of  deaths  in  1910.  It  is  the  tropical  disease  most  to  be  appre- 
hended by  Americans. 

Typhoid  fever,  in  the  Philippines,  shows  a  much  lower  rate  for 
the  Filipino  scouts  and  natives  generally  than  for  white  troops;  for 
the  latter  the  admission  rate  exceeds  that  for  troops  serving  in  the 
United  States,  showing  that  the  comparative  immunity  of  the  natives 
is  not  a  matter  of  climate  but  rather  of  racial  resistance,  or  of  diet. 

The  so-called  tropical  anemia  of  the  natives  which  has  been  gen- 
erally attributed  to  depressive  climatic  influences,  is  now  regarded 
as  secondary  to  certain  specific  diseases  or  the  result  of  several 
causes  combined,  such  as  malaria,  uncinariasis  and  semi-starvation. 

In  conclusion  it  may  be  said  that :  Any  soldier,  in  the  tropics,  who 
takes  an  intelligent  interest  in  the  sanitary  measures  enacted  for  his 
benefit  and  cheerfully  complies  therewith,  who  reasonably  adapts 
his  diet  to  the  climate,  keeps  away  from  the  hot  sun  when  off  duty, 
and  shuns  the  saloon  and  brothel,  has  as  good  chances  of  health  and 
longevity  as  in  temperate  climates. 


CHAPTER    LVIII. 
SERVICE  IN  COLD  CLIMATES. 

A  temperature  of  40°  to  45°  F.  below  zero  is  not  uncommon  in 
some  of  our  interior  northern  States,  while  a  still  more  intense  cold 
is  experienced  in  parts  of  Alaska.  The  coldest  day  recorded  by 
Nansen  in  "  Farthest  North  "  while  drifting,  only  a  few  degrees 
from  the  pole,  was  on  January  15,  when  the  temperature  ranged 
from  —58°  to  — 61.6°  F.  At  Cape  Sheridan  (lat.  82.30°),  the 
coldest  month  recorded  in  1909  was  February,  with  mean  tem- 
perature of  — 31.71°,  and  the  lowest  minimum  — 52°,  in  March. 
The  mean  of  February  at  Fort  Conger  (lat.  81.30°),  in  1881-1883, 
was  — 40.13°.  For  comparison,  it  may  be  mentioned  that  the  mean 
temperature  of  February  along  our  northern  boundary  line  (49° 
of  lat.)  seldom  falls  below  zero.  When  Peary  left  Camp  Columbia, 
March  13,  (lat.  83°)  for  his  dash  to  the  pole,  the  temperature  was 
— 53°  and  reached  — 59°  in  the  evening.  He  notes  that  as  there 
was  no  wind  the  cold  was  not  unbearable.  At  the  pole,  on  April 
6  and  7,  the  temperature  ranged  from  — 11°  to  — 30°.  The  lowest 
temperature  recorded  by  Amundsen  in  his  winter  quarters  at  the 
Bay  of  Whales,  in  the  Antarctic  Circle,  was  — 74°  F.,  on.  August  13. 

In  northern  latitudes,  when  the  air  is  dry  and  perfectly  still,  the 
temperature  falls  to  its  lowest  point,  to  rise  again  as  soon  as  the 
air  becomes  disturbed  by  wind  currents.  Such  calm  cold,  although 
intense,  is  much  more  bearable  than  a  lesser  cold  with  wind  blow- 
ing, for  the  body  becomes  surrounded  with  a  layer  of  air  warmer 
than  the  atmosphere  and  loses  less  heat.  It  is  the  blizzard  that 
constitutes  the  dangerous  feature  of  the  winter  of  our  northwestern 
States.  As  explained  in  another  place  (page  514),  the  same  degree 
of  cold  is  much  more  bearable  if  dry  than  if  damp;  thus  a  tem- 
'perature  of  — 10°  or  — 15°  in  Dakota  is  less  trying  and  depressing 
than  one  of  zero  on  the  shores  of  the  Great  Lakes,  causing  a  smaller 
loss  of  animal  heat  from  the  body. 

That  man  can  maintain  himself  in  excellent  health  and  lead  an 
active  life  in  climates  with  extreme  winter  cold  has  been  amply 
demonstrated.  It  has  also  been  shown  that,  with  proper  food  and 

712 


SERVICE    IN    COLD   CLIMATES.  713 

clothing,  it  is  possible  for  troops  to  conduct  an  active  campaign  in 
winter  snow  and  ice,  with  temperature  often  below  zero.  Several 
of  our  successful  Indian  campaigns  were  thus  prosecuted  without 
a  single  death  from  congelation  or  serious  accident  attributable  to 
the  cold.  During  the  Russo-Japanese  War,  one  of  the  bloodiest 
battles,  lasting  several  days,  was  fought  in  January,  with  tem- 
perature from  8°  to  12°  below  zero,  a  sharp  wind  blowing  from  the 
north  during  much  of  the  time;  there  were  many  cases  of  frost-bite, 
'but  most  of  them  could  have  been  prevented  by  proper  hand  and 
foot  covering. 

Severe  cold  causes  loss  of  body  temperature  by  conduction  and 
radiation,  and  reduces  the  force  and  frequency  of  the  pulse.  It 
constricts  the  cutaneous  capillaries  and  greatly  diminishes  perspira- 
tion, while  the  urine  is  correspondingly  increased.  Should  the  ex- 
posure be  prolonged  and  severe,  the  contracting  superficial  arterioles 
do  not  permit  enough  blood  to  reach  the  extremities  which  become 
blanched  and  frost-bitten.  Frost-bite,  in  hands  and  feet,  is  gen- 
erally accompanied  by  a  sharp  tingling  pain,  but  may  also  manifest 
itself,  especially  when  the  result  of  intense  dry  cold,  by  a  painless 
ivory-white  spot  on  the  cheek,  nose  or  ear.  In  general  refrigera- 
tion, after  long  exposure,  the  patient  experiences  difficulty  in  speak- 
ing; his  sight  grows  dim  and  his  faculties  fail  him;  muscular  exer- 
tion becomes  difficult  and  he  staggers  like  a  drunken  man;  he  is 
overcome  by  a  sense  of  languor  and  an  irresistible  desire  to  go  to 
sleep,  a  sleep  which  leads  to  coma  and  death. 

To  combat  cold  successfully,  the  system  endeavors  to  produce 
more  animal  heat  by  an  increased  demand  for  food  and  by  stimulat- 
ing the  digestive  and  assimilative  functions,  while  the  combustion 
of  tissues  and  elimination  of  wastes  are  more  rapid  and  complete. 
The  food,  in  very  cold  climates,  should  be  abundant  and  rich  in  fats 
(fat  meats,  bacon  or  pork,  oil  and  butter).  The  Eskimo  is  said  to 
eat  12  to  15  pounds  of  fat  meat,  raw  or  cooked,  daily,  when  able  to 
procure  it,  and  to  be  very  fond  of  raw  blubber  and  walrus  beef. 
The  increased  desire  for  rich  food,  in  northern  latitudes,  may  be 
safely  indulged  provided  one  performs  active  work,  or  takes  brisk 
exercise;  but,  with  a  quiet  or  idle  life,  this  desire  should  be 
restrained  and  regulated,  otherwise  accidents  of  auto-infection  or 
disorders  of  nutrition  are  sure  to  result. 

The  conclusions  reached  by  Peary  as  to  the  best  diet  for  strenu- 


714  MILITARY    HYGIENE. 

ous  work  in  the  Arctic  Circle  contain  information  of  practical  value 
to  any  military  command  operating  in  very  cold  latitudes.  In  his 
opinion,  the  only  food  essentials  needed  under  such  circumstances, 
no  matter  what  the  season,  the  temperature  or  the  duration  of  the 
journey  might  be,  are  four:  pemmican,  tea,  ship's  biscuit  and  con- 
densed milk.  Pemmican,  he  writes,  "  may  be  regarded  as  the  most 
concentrated  and  satisfying  of  all  meat  foods  and  is  absolutely 
indispensable  in  protracted  Arctic  sledge  journeys."  (See  composi- 
tion, page  335.)  In  all  his  journeys  towards  the  pole,  the  standard 
daily  ration  was :  pemmican,  I  pound ;  ship's  biscuit,  I  pound ;  con- 
densed milk,  4  ounces;  compressed  tea,  ^  ounce;  liquid  fuel  (al- 
cohol or  petroleum),  6  ounces;  a  total  of  2  pounds  10^  ounces  for 
ration  and  fuel.  Of  this,  Peary  says :  "  I  believe  that  no  other 
item  of  food,  either  for  heat  or  muscle  building,  is  needed." 

Of  the  trip  culminating  in  the  discovery  of  the  south  pole,  Amund- 
sen writes :  "  For  food  we  relied  entirely  on  pemmican,  biscuits, 
chocolate,  powdered  milk  and,  of  course,  dog  meat.  The  dogs  were 
fed  on  pemmican.  In  my  opinion  we  had  the  best  and  most  satis- 
fying provisions  possible."  The  pemmican  contained  oatmeal  and 
vegetables  as  well  as  meat  and  fat.  The  biscuits  consisted  of  oat- 
meal, powdered  milk  and  sugar.  The  powdered  milk  "  proved  a 
splendid  thing  "  as  it  packs  and  keeps  well  under  all  circumstances. 

Experience  has  shown  that  alcoholic  drinks,  except  in  great 
moderation,  are  especially  dangerous  in  cold  countries,  and  that  men 
are  healthier  and  capable  of  greater  endurance  to  cold  and  fatigue 
without  them.  This  has  led  to  the  entire  suppression  of  the  daily 
dose  of  rum  or  whiskey  which  was  formerly  part  of  the  ration  of 
the  crews  of  whaling  vessels  and  other  ships  cruising  in  the  northern 
eeas.  When  Nansen  sailed  for  the  north  pole,  the  only  spirits  on 
board  his  ship  were  a  few  bottles  of  cognac  in  the  doctor's  stores ; 
he  returned  after  a  three  years'  strenuous  cruise  with  every  member 
of  his  expedition  in  the  best  of  health.  According  to  Pierson,  of 
(the  Medical  Corps,  who  spent  several  years  in  Alaska,  alcohol,  for 
anybody  exposed  to  extreme  cold,  is  almost  suicidal,  having  a  prompt 
and  overpowering  effect  upon  the  nervous  system.  Amundsen, 
after  describing  the  bill  of  fare  of  his  men  while  wintering  near  the 
south  pole,  adds :  "  Every  Saturday  evening  a  glass  of  toddy  and 
a  cigar,"  thus  showing  it  was  not  a  common  and  regular  indulgence. 
On  sledge  journeys,  says  he,  "  we  all  know  from  experience  that 


SERVICE    IN    COLD   CLIMATES.  715 

spirits  must  be  banished/'  because  weight  and  space  must  be  saved 
and  he  does  not  regard  spirits  as  one  of  the  necessary  things. 

The  most  suitable  clothing  is  woolen  undergarments  and  fur 
outer  garments.  Too  much  clothing  is  uncomfortable  and  unsafe 
while  marching  or  exercising ;  the  undergarments  become  dampened 
with  perspiration  and  there  is  danger  of  chilling  of  the  body  sur- 
face from  rapid  evaporation  at  the  next  halt.  The  underwear 
should  only  be  of  medium  weight  and  thickness  in  post  or  camp, 
and  when  more  warmth  is  needed  it  should  be  obtained  chiefly  by 
outer  clothing  which  can  be  changed  or  removed  as  desired.  The 
buffalo  fur  coat  formerly  worn  by  officers  and  men  in  winter 
expeditions  is  now  replaced  by  a  thick  canvas  overcoat  lined  with 
heavy  blanket  cloth.  Buckskin  suits  are  excellent,  keeping  out  the 
cold  wind  and  saving  the  body  heat  without  impeding  overmuch  the 
aeration  of  the  skin. 

The  extremities  require  special  attention.  In  very  cold  weather 
leather  shoes  are  of  little  use;  they  do  not  keep  the  feet  warm,  and 
are  very  slippery.  But  they  are  necessary  when  the  ground  is  damp 
or  muddy,  as  after  a  thaw ;  in  such  case  they  should  be  oiled  or 
otherwise  made  waterproof.  Wetting  of  the  foot-gear  renders  the 
danger  of  frost-bite  serious  and  constant.  The  socks  should 
always  be  perfectly  dry  before  being  put  on.  According  to  Pier- 
son,  so  long  as  the  ground  is  dry  and  frozen  there  is  nothing  better 
than  German  socks  and  moccasins,  the  usual  foot-gear  of  the 
Alaskan  mail  carriers.  Likewise  very  suitable  are  the  woolen 
stockings,  felt  shoes  and  Arctic  overshoes  provided  by  the  Q.  M. 
Corps.  Care  must  be  taken  that  the  feet  are  not  compressed,  and 
that  nothing  interferes  with  the  free  circulation  of  blood  in  the 
toes.  For  the  hands,  mittens  are  better  than  gloves,  and  the  fur 
mittens  of  muskrat  skin  lined  with  lamb's  fleece,  issued  to  our  sol- 
diers in  very  cold  latitudes,  can  hardly  be.  excelled.  Mittens  of  tan 
buckskin  are  also  provided  when  needed.  They  should  be  several 
sizes  larger  than  the  hands  so  as  to  permit  the  latter  to  slip  in  and 
out  easily,  or  the  wearing  of  the  woolen  knitted  glove  inside  of 
them.  The  half-breed's  way  of  wearing  his  mittens,  tied  to  both 
ends  of  a  cord  passing  around  his  neck,  secures  them  against  loss, 
and  otherwise  saves  time  and  trouble,  especially  when  the  soldier 
is  obliged  to  withdraw  his  hands  to  handle  his  gun. 

For  the  head,  the  fur  muskrat  cap  formerly  issued  to  the  men  is 


716  MILITARY    HYGIENE. 

a  most  excellent  covering.  It  has  been  replaced  by  the  less  expensive 
canvas  cap  lined  with  olive-drab  kersey,  with  visor  to  protect  the 
face,  and  extended  below  into  a  cape  to  cover  the  neck  and  throat. 
A  very  useful  and  popular  type  of  cap  in  cold  countries  is  that  with 
adjustable  side  pieces  tied  across  the  top  in  mild  weather,  but  let 
down  and  tied  under  the  chin  in  cold  weather,  thus  protecting  the 
ears,  sides  of  the  face,  throat  and  chin.  The  hood  of  the  Army 
overcoat  would  be  improved,  for  service  in  high  latitudes,  by  the 
addition  of  a  fur  edging  which  keeps  out  the  cold  without  collecting 
frost  from  the  moisture  of  the  breath. 

For  bedding,  the  best  device  is  the  sleeping-bag  of  the  Arctic  ex- 
plorer and  Canadian  voyageur,  made  of  strong  canvas  lined  with 
fur.  However,  inasmuch  as  no  part  can  be  removed  so  as  to  adjust 
it  to  variations  of  temperature,  it  is  not  desirable  in  changeable 
weather  or  in  the  proximity  of  a  fire.  (See  page  468.)  Fur  robes 
are  always  useful. 

In  marching,  certain  precautions  are  required.  If  the  face  suffers 
from  the  cold  it  should  be  anointed  with  cold  cream,  vaseline  or  any 
kind  of  grease.  Bright  sunlight  reflected  from  the  snow  produces 
a  painful  glare,  sometimes  strong  enough  to  cause  snow  blindness, 
an  affection  which  begins  with  pricking  sensations  in  the  eyeballs 
and  lasts  from  a  few  hours  to  one  or  two  weeks.  To  guard  against 
this  glare  the  Eskimos  wear  wooden  spectacles  with  a  slit  cut 
through  the  eye  pieces.  Colored  glasses  are  also  useful.  The  best 
protection  is  afforded  by  goggles  with  amber  glass  which  excludes 
the  injurious  glare  without  interfering  with  the  acuity  and  range  of 
vision.  The  metal  parts  of  spectacles  in  contact  with  the  skin  should 
always  be  wrapped  in  wool.  Inasmuch  as  glasses  may  become 
steamed  and  have  to  be  frequently  wiped,  some  writers  recommend 
the  use  of  a  piece  of  thin,  black  crepe  fastened  to  the  front  of  the 
cap  or  hat  and  falling  over  the  eyes  like  a  veil. 

The  column  should  march  in  close  order  so  that  the  men  may 
shelter  and  protect  one  another.  No.  straggling  must  be  permitted. 
There  is  always  great  danger  that  men  exhausted  by  the  march, 
mentally  and  physically  benumbed  by  the  cold,  may  drop  out,  if 
unobserved,  yield  to  their  intense  desire  to  go  to  sleep  and  freeze  to 
death ;  then  "  whoever  stops  goes  to  sleep,  and  whoever  goes  to  sleep 
wakes  no  more."  Such  men  must  be  urged,  helped,  shaken  and  kept 
awake  at  all  hazards  until  shelter  is  available  and  rest  possible. 


SERVICE    IX    COLD    CLIMATES.  7 1/ 

When  undertaking  long  marches  in  very  cold  weather,  a  sufficient 
supply  of  tea  and  coffee  should  always  be  on  hand,  along  with  small 
portable  spirit  lamps  or  oil  stoves.  Alcoholic  stimulants,  when 
deemed  necessary,  may  be  used  in  small  doses  cautiously  repeated. 

Here  may  be  mentioned  the  Japanese  "  pocket  stove  "  which  many 
Japanese  soldiers  carried  on  their  persons  in  Manchuria  during  the 
Russo-Japanese  War;  it  is  semi-cylindrical  in  shape,  one  foot  long 
and  four  inches  in  diameter ;  a  slow  burning  powder  is  the  fuel  and 
a  pleasant  warmth  is  thus  readily  produced. 

In  frost-bite  there  is  more  or  less  congelation  of  tissue  and  arrest 
of  circulation.  Its  intelligent  treatment  requires  some  knowledge 
of  its  pathology.  As  the  blood  of  the  exposed  part  freezes,  the 
water,  of  which  it  mostly  consists,  expands  (as  when  ice  is  formed) 
and  stretches  the  constricted  capillaries  which  are  thus  more  or  less 
injured.  If  the  part  is  rapidly  thawed  out  by  the  application  of 
heat,  the  circulation  is  restored  before  the  capillaries  have  time  to 
recover  enough  of  their  tone  and  integrity  to  withstand  the  full  force 
of  the  blood  pressure.  The  result  is  continued  paralysis  of  the 
blood-vessels,  with  stasis  and  possibly  necrosis  and  gangrene.  To 
prevent  such  serious  danger,  the  circulation  must  be  restored  very 
slowly,  so  that  the  walls  of  the  arterioles  may  recover  nearly  their 
normal  state  by  the  time  the  blood  begins  to  flow.  When  an  ex- 
posed part  is  in  danger  of  becoming  frozen,  it  is  enough  to  rub  it 
with  the  hand  or  the  back  of  the  mitten.  If  it  be  blanched  and  actu- 
ally frosted,  snow  should  be  rubbed  on  it,  gently  but  persistently  until 
the  blood  returns  to  the  skin.  In  case  of  a  frost-bitten  extremity, 
immersion  in  ice-cold  water,  with  continuous  frictions,  must  be  kept 
up  until  the  muscular  tone  of  the  arterioles  is  sufficiently  restored  to 
prevent  stasis,  that  is  to  say,  one  or  two  hours  after  the  return  of 
the  circulation.  If  upon  removing  the  frost-bitten  part  from  the 
water,  it  becomes  blue,  thus  giving  evidence  of  stasis,  it  should  be 
put  back  again.  Hot  water,  as  hot  as  can  be  borne,  is  recommended 
by  some  Russian  writers  who  claim  excellent  results  from  this  mode 
of  treatment,  with  much  less  discomfort  to  the  patient.  Although 
the  blood  is  thus  quickly  thawed  out,  the  capillaries  are  stimulated 
and  kept  constricted  by  the  heat,  checking  the  circulation  until  they 
have  recovered  their  normal  tone. 

Cold  countries,  that  is,  those  in  which  a  freezing  temperature  per«- 
sists  for  long  periods  without  thaw,  are  generally  very  healthy, 


718  MILITARY    HYGIENE. 

Alaska  (for  whites)  is  the  healthiest  part  of  all  the  territory  under 
the  flag  of  the  United  States.  Their  prevalent  diseases,  namely, 
colds,  tonsillitis,  bronchitis,  etc.,  are  those  which  result  from  the 
usual  tendency  of  people,  in  cold  weather,  to  crowd  together  in  over- 
heated and  ill-ventilated  rooms,  neglecting  open-air  exercise  and  the 
requirements  of  personal  hygiene.  As  would  be  expected  under 
such  conditions,  any  epidemic  breaking  out  is  liable  to  spread  rapidly. 
Pneumonia  is  very  rare  in  Arctic  regions.  Tuberculosis  among  the 
Esquimos  is  frightfully  prevalent  (4  per  cent.),  showing  how  dan- 
gerous is  the  neglect  of  ordinary  measures  of  prophylaxis  even  in 
the  most  favorable  climates.  A  common  disease  in  Alaska,  accord- 
ing to  Pierson,  is  the  "  chichoker  "  knee,  a  painful  local  inflammation 
of  low  grade  with  stiffening  of  the  joint,  due  to  exposure.  It  is 
prevented  by  wearing  some  form  of  knee  protector.  Peary  notes 
the  interesting  phenomenon  that  outbreaks  of  grip  among  Arctic 
explorers  have  generally  been  coincident  with  epidemics  of  this  dis- 
ease in  Europe  and  America. 

In  the  case  of  general  congelation,  the  patient  must  not  be  carried 
at  once  into  a  warm  place,  but  kept  for  a  while  in  a  shed  or  fireless 
room ;  there  the  body  is  rubbed  with  dry  towels  and  the  extremities 
treated  as  in  frost-bite;  heart  stimulants  will  probably  be  needful. 


CHAPTER   LIX. 

AM)  DISIUFECTANTS. 


(See  also  Insecticides.) 

The  term  disinfectant,  although  popularly  used  in  a  more  compre- 
hensive sense,  should  be  restricted  to  any  substance  which  destroys 
the  specific  germs  and  toxins  of  infectious  diseases.  It  is  practically 
synonymous  with  germicide.  Disinfection,  therefore,  consists  in  the 
destruction  of  pathogenic  germs.  Sterilisation  has  a  more  extended 
sense  and  means  the  destruction  of  all  micro-organisms.  Antiseptics 
are  substances  which,  without  killing  organisms,  lower  their  vitality 
so  as  to  arrest  their  power  of  propagation,  thereby  restraining  or 
preventing  die  decomposition  of  organic  matters.  Deodorants  merely 
oxidize  the  products  of  decomposition  and  thereby  correct  or  destroy 
offensive  odors  without  any  direct  effect  upon  .the  causal  organisms. 

The  lines  separating  disinfectants,  antiseptics  and  deodorants  are 
not  strictly  drawn,  most  substances  in  either  class  sharing  also,  more 
or  1*~5S,  the  properties  of  the  other  classes;  thus  disinfectants,  when 
used  in  small  doses,  lose  their  power  to  destroy  germs  and  become 
simply  antiseptics  ;  for  instance,  formalin  which  is  an  *IGe*f*A  germ- 
icide in  a  strength  of  5  per  cent.,  is  only  an  antiseptic  and  deodorant 
in  a  strength  of  I  per  3.000. 

Disinfectants  are  conveniently  divided  into  physical  and  chemical. 
The  physical  include  air,  sunlight  and  heat. 

AIR  AND  LIGHT. 

Fresh  air  and  sunlight,  especially  on  account  of  their  availability 
at  all  times,  have  great  value  as  disinfectants  or  aids  to  disinfection. 
Fresh  air  oxidizes  the  organic  dust  of  buildings  and  thus  removes 
much  of  the  pabulum  of  bacteria  ;  it  acts  much  more  efficiently  under 
die  influence  of  the  solar  rays.  Direct  sunlight,  chiefly  through  the 
actinic  effect  of  the  ultra-violet  rays,  has  a  strong  restraining  action 
on  the  growth  of  bacteria  and  kills  most  of  them.  According  to 
J.  Wemzirl*  it  destroys  all  non-spore  bearing  bacteria  in  from  2  to  10 

*/.  /*/.  Dis.,  May,  1907. 

719 


/2O  MILITARY    HYGIENE. 

minutes.  The  germs  of  plague,  typhoid  fever  and  cholera  are 
particularly  sensitive  to  it.  This  effect  of  light  is  materially  in- 
creased by  heat,  and  is  most  marked  with  clear,  warm  atmosphere. 
Diffuse  light  is  much  less  efficient  but  also  very  useful.  Germs 
floating  in  dry  air  become  desiccated  and,  in  this  state,  lose  their 
power  of  propagation  and  often  their  vitality.  There  is  considerable 
difference,  however,  in  their  resistance,  those  of  tuberculosis  and 
diphtheria,  for  instance,  can  endure  desiccation  for  weeks,  while 
those  of  plague,  cholera  and  typhoid  fever  are  killed  in  a  few  hours. 

From  the  above  remarks  it  follows  that  nature  provides  us  with 
simple  and  useful  means  of  disinfection  and  antisepsis  which  should 
not  be  neglected.  These  are  the  thorough  ventilation  and  sunning 
of  dwellings,  the  airing,  shaking  and  sunning  of  clothing,  bedding, 
carpets,  hangings,  etc.  In  garrisons,  the  bedding,  clothing  and  much 
of  the  equipment  of  the  men  should  be  regularly  aired  and  shaken 
once  a  week,  even  in  the  absence  of  sunlight. 

The  sterilizing  influence  of  sunlight  on  the  bacteria  of  drinking 
water  is  very  remarkable.  Thus,  within  a  depth  of  2  or  3  feet,  the 
germs  of  typhoid  fever  and  cholera  are  quickly  oxidized.  In  clear 
water  this  destructive  effect  extends  to  a  depth  of  5  or  6  feet.  It  is 
advisable,  therefore,  for  this  and  other  reasons,  to  draw  the  water 
from  near  the  surface  of  streams  and  ponds. 

HEAT. 

Heat  may  be  used  dry  or  moist. 

Dry  Heat.  —  This  is  hardly  ever  used  for  disinfection.  It  requires 
such  a  high  temperature  for  its  action  that  it  is  liable  to  scorch  ex- 
posed articles,  especially  woolen  materials ;  it  acts  very  slowly,  and 
has  such  a  low  power  of  penetration  as  to  make  it  useless  for  the 
disinfection  of  bulky  articles  like  mattresses  and  folded  blankets. 

Moist  Heat.  —  This  is  used  in  the  form  of  boiling  water  and 
steam.  Boiling  is  a  simple  and  efficient  method  of  disinfection, 
especially  for  cotton  and  linen  goods,  as  well  as  cuspidors,  bed  pans, 
urinals  and  a  great  variety  of  objects.  In  half  an  hour  it  destroys 
all  bacteria.  It  is  not  applicable  to  woolen  goods  which  shrink  and 
lose  their  elasticity,  nor  to  leather  and  rubber  goods  which  become 
hard  and  brittle.  It  has  also  the  objection  of  fixing  and  rendering 
indelible  albuminous  stains  such  as  those  from  blood,  pus  and  ex- 
creta ;  fabrics  so  stained  should  first  be  soaked  and  rubbed  in  cold 


DISINFECTION    AND   DISINFECTANTS.  721 

water  to  which  a  little  washing  soda  is  added.  For  the  disinfection 
of  bright  steel  objects  or  cutting  instruments,  the  addition  of  I  per 
cent,  of  soda  will  prevent  rusting  and  injury  to  the  cutting  edge. 


FIG.  234. —  Section  of  Arnold 
steam  sterilizer. 

STEAM.  —  All  things  considered,  steam  is  the  best  and  most  useful 
of  disinfectants,  being  cheap,  reliable,  quick,  easily  manipulated  and 
applicable  to  a  majority  of  the  articles  requiring  disinfection.  It  is 
used  saturated  or  superheated. 

Saturated  steam  is  steam  as  it  streams  or  flows  from  boiling  water 
under  atmospheric  pressure  only.  It  is  entirely  reliable  for  many 
practical  purposes,  killing  most  bacteria  in  a  few  minutes.  It  has 
but  little  power  of  penetration  and  therefore  can  only  be  used  for 
small,  loose  articles,  or  for  the  sterilization  of  dressings  in  operating 
rooms.  It  is  successfully  utilized  in  the  Arnold  sterilizer  commonly 
issued  to  our  post  hospitals  (Fig.  234)  ;  from  the  pan,  the  water 
passes  slowly  into  the  shallow  boiler  from  which  the  steam  rises  into 
the  sterilizing  chamber ;  the  water  resulting  from  condensation  drips 
back  into  the  pan ;  as  the  heat  is  turned  off,  the  hood  and  lid  should 
be  removed  in  order  to  let  the  steam  escape  and  prevent  the  wetting 
of  the  sterilized  articles  which  would  result  from  its  condensation. 

Disinfection  with  streaming  steam  can  be  readily  effected  without 
the  use  of  special  apparatus,  whenever  a  tin  boiler  is  found  to  fur- 
nish the  steam;  sticks  are  laid  across  the  top  and  the  material  to 
be  disinfected  placed  over  them ;  the  whole  should  be  covered  with 
a  sheet  to  retain  the  heat,  and  steamed  for  at  least  an  hour. 


722 


MILITARY    HYGIENE. 


- 


DISINFECTION    AND   DISINFECTANTS. 


723 


Superheated  steam  is  steam  under  pressure,  and  so  heated  that  it 
can  be  cooled  without  condensing,  and  even  take  up  moisture  from 
surrounding  objects.  It  is  the  form  commonly  used  for  general  dis- 
infection. Superheated  steam  at  230°  F.  will  destroy  not  only  all 


FIG.  236. —  Ground  plan  of  disinfecting  plant,  Fort  Slocum,  N.  Y. 
(Kensington  Engine  Works  Co.) 

bacteria  but  the  most  resistant  spores  in  a  few  minutes.  It  does  not 
injure  cotton  and  linen  articles,  nor  most  household  effects,  but  is 
quite  apt  to  shrink  woolens  and  damage  silk  fabrics,  while  it  ruins 
furs,  leather,  felt  and  rubber  goods.  As  in  the  case  of  boiling  water, 
spots  of  blood,  pus  or  feces  should  be  removed  prior  to  disinfection. 
Steam  sterilizers  of  various  types  are  found  in  all  large  hospitals 
and  public  institutions  not  only  for  the  sterilization  of  infected  arti- 
cles whenever  required,  but  also  for  the  systematic  sterilization  of 
the  clothing  and  effects  of  all  inmates  admitted  therein,  as  a  measure 
of  prevention.  For  the  use  of  permanent  camps  or  cantonments, 
sterilizers  mounted  on  wheels  so  as  to  be  drawn  to  any  required 
place,  will  often  answer  an  excellent  purpose. 


724 


MILITARY    HYGIENE. 


"  "- 


FIG.  237.  —  Pavilion  for  infectious  diseases. 
Front  elevation. 


U.  S.  Army  hospitals. 


The  ordinary  apparatus  (Fig.  235)  consists  of  a  chamber  of  steel 
large  enough  to  admit  mattresses  and  other  bulky  packages,  with  an 
outer  jacket  of  same  metal,  and  an  intervening  space  of  two  inches. 
At  each  end  is  a  door  made  to  fit  air-tight.  Inside  and  outside  the 
chamber  are  rails  upon  which  rolls  a  car  for  convenience  of  loading 
and  unloading.  To  operate  it,  the  steam  is  first  let  into  the  jacket 
so  as  to  warm  the  chamber  and  thus  prevent  the  condensation  of  the 
steam  which  would  otherwise  occur  when  first  introduced.  The 
goods  are  then  placed  in  the  car,  rolled  into  the  chamber  and  the 
doors  closed  and  made  steam-tight.  The  steam  exhauster  is  now 
turned  on  until  a  vacuum  of  15  to  20  inches  is  obtained;  this  re- 
moves the  air  and  moisture  from  the  chamber  and  its  contents.  Air 
in  the  chamber  would  interfere  with  the  penetrating  action  of  the 
steam  and  retard  the  attainment  of  the  required  temperature.  Steam 
is  then  admitted  and  a  temperature  of  230°  to  240°  F.  maintained  for 
about  15  minutes,  when  another  partial  vacuum  is  made.  A  current 
of  air  is  now  drawn  through  the  chamber,  the  outer  door  opened  and 
the  contents  removed.  As  the  result  of  the  combined  action  of  the 
vacuum  and  fresh  air  inlet,  the  contents  are  found  to  be  completely 
dry  after  3  or  4  minutes'  exposure. 


DISINFECTION    AND   DISINFECTANTS. 


725 


FIG.  238. —  Pavilion  for  infectious  diseases. 
Basement  plan. 


U.   S.  Army  hospitals. 


It  has  been  stated  above  that  certain  articles  are  injured  by  steam. 
They  may  be  safely  disinfected  with  formaldehyde  under  pressure, 
in  a  partial  vacuum ;  for  this  purpose,  steam  chambers  are  generally 
provided  with  a  formaldehyde  attachment,  used  as  described  on  page 

735- 

The  body  of  the  apparatus  should  pass  through  a  partition  wall  so 
that  the  ends  of  the  chamber  open  into  separate  rooms,  one  room 
being  used  for  the  reception  of  infected  articles  and  the  other  for 
their  delivery  after  sterilization.  (Fig.  236.) 

Our  larger  military  posts  have  a  separate  pavilion  for  infectious 
diseases  (Figs.  237,  238,  239)  which  is  supplied  with  a  complete  dis- 
infecting outfit  in  the  basement,  generally  consisting  of  the  Kinyoun- 
Francis  circular  disinfecting  chamber  with  the  usual  formaldehyde 
retort  attachment. 


726 


MILITARY    HYGIENE. 


FIG.  239. —  Pavilion  for  infectious  diseases.     U.   S.  Army  hospitals. 
First  floor  plan. 


In  such  a  pavilion  it  is  generally  impossible  to  assign  separate 
floors  or  parts  of  the  building  to  different  infections.  It  should  con- 
sist of  separate  rooms,  each  completely  isolated.  Patients  are  ad- 
mitted to  any  vacant  rooms,  as  they  come,  according  to  convenience 
and  regardless  of  contiguous  cases.  This  plan,  for  a  post,  has  been 
found  to  give  the  best  results,  requiring  a  smaller  building,  smaller 
personnel  and  insuring  better  care  to  the  patients. 


CHEMICAL    DISINFECTANTS. 

Chemical  disinfectants  are  conveniently  divided  into  those  which 
are  used  in  aqueous  solution  and  those  used  under  the  form  of  gas. 


DISINFECTION    AND   DISINFECTANTS.  727 

GASEOUS  DISINFECTANTS. 

Of  the  several  substances  belonging  to  this  class,  only  few  are  of 
practical  importance,  namely,  chlorin,  sulphur  dioxid  and  formal- 
dehyde. 

CHLORIN.  —  This  gas  has  powerful  disinfecting  properties,  but 
on  account  of  its  high  specific  gravity  which  prevents  an  even  diffu- 
sion, its  lack  of  penetrating  power,  bleaching  effects  on  colors  and 
destructive  action  on  fabrics,  is  very  seldom  used  to  disinfect  rooms, 
clothing  or  household  effects.  Its  principal  application  is  in  the 
purification  of  water  (page  283). 

SULPHUR  DIOXID,  SO2.  —  This  gas,  produced  by  the  burning  of 
sulphur,  has  long  been  considered  one  of  our  most  reliable  disinfec- 
tants, probably  on  account  of  its  pungent,  irritating  and  persistent 
odor,  and  is  still  largely  employed.  The  experiments  of  most  bac- 


FIG.  240. —  Pan  for  burning  sulphur. 

teriologists,  however,  have  demonstrated  that,  although  it  has 
undoubted  germicidal  properties  under  certain  favorable  conditions, 
it  is  untrustworthy  for  general  disinfection.  Plenty  of  moisture  is 
necessary  for  its  action  but,  even  with  it,  its  power  of  penetration  is 
always  feeble,  while  its  high  specific  gravity  renders  its  even  diffu- 
sion almost  impossible.  Furthermore,  it  bleaches  fabrics  or  mate- 
rials dyed  with  vegetable  or  anilin  dyes,  injures  most  metals,  and  as 
part  of  it  becomes  oxidized,  the  resulting  sulphuric  acid  corrodes  the 
fiber  of  linen  and  cotton  goods,  seriously  weakening  their  tensile 
strength.  Whenever  used  as  a  disinfectant,  5  pounds  of  sulphur 
should  be  burned  to  each  1,000  cubic  feet  of  space  to  produce  any 
marked  effect.  The  sulphur,  broken  into  small  fragments,  is  placed 
in  a  broad  and  shallow  iron  pot  which  is  itself  set  on  bricks  in  a  tub 
of  water,  to  guard  against  the  danger  of  fire,  and  is  ignited  after 
being  freely  wetted  with  alcohol.  (Fig.  240.)  The  necessary  mois- 
ture is  automatically  produced  from  the  water  in  the  tub.  The  room 


728  MILITARY    HYGIENE. 

should  previously  be  sealed  tight  in  order  to  prevent  leakage  of  the 
gas. 

It  is  as  a  fumigant  that  sulphur  dioxid  finds  its  most  useful  appli- 
cation. Sulphur  fumes  are  most  effective  in  the  destruction  of  rats, 
mice,  roaches,  bedbugs,  flies  and  mosquitoes,  and,  for  this  purpose, 
act  best  in  dry  air,  without  added  moisture.  As  an  insecticide,  2 
pounds  of  sulphur  to  each  1,000  cubic  feet  of  space  are  enough. 

Sulphur  dioxid  can  also  be  used  in  the  liquid  form.  The  process 
consists  simply  in  inverting  the  can  containing  it  in  a  metal  or  earthen 
vessel,  when  volatilization  takes  place  rapidly.  It  is  free  from  any 
danger  of  fire  and  has  also  the  advantage  of  liberating  a  large  quan- 
tity of  gas  in  a  short  time,  but  costs  ten  times  as  much  as  the  method 
of  burning  sulphur.  For  disinfection,  ten  pounds  of  liquid  sulphur 
are  required  for  every  1,000  cubic  feet.  The  necessary  moisture 
must  be  specially  provided. 

Wherever  sulphur  dioxid  is  used  on  a  large  scale,  as  at  quarantine 
stations,  special  and  highly  efficient  appliances  have  been  devised, 
such  as  the  "  sulphur  furnace  "  and  the  "  Roberts'  sulphur  stove." 

FORMALDEHYDE,  CH2O.  —  A  colorless,  pungent  gas,  extremely 
irritating  to  the  mucous  membrane  of  the  nose  and  eyes,  and  of  the 
same  specific  gravity  as  air  in  which  it  diffuses  evenly.  It  is  a 
product  of  oxidation  of  wood  alcohol  and  is  soluble  in  water  up  to 
40  per  cent.,  forming  the  solution  known  in  trade  as  formalin.  If  the 
latter  be  concentrated  by  heat,  the  gas  is  changed  into  a  white  crys- 
talline solid  by  polymerization,  called  para  formaldehyde  or  simply 
paraform  (C3H0O3),  consisting  of  3  molecules  of  formaldehyde. 
The  gas  is  changed  in  the  same  manner  when  generated  in  a  cold 
room  or  at  a  low  temperature.  The  readiness  with  which  it  is  thus 
polymerized  into  an  inert  substance  is  one  of  the  drawbacks  to  its 
use. 

Formaldehyde  is  the  strongest  and  most  practically  efficient  gas- 
eous disinfectant  known.  It  is  applicable  to  the  disinfection  of 
rooms,  clothing,  fabrics,  effects  and  furniture,  but  cannot  be  de- 
pended upon  for  mattresses,  upholstered  furniture,  and  the  like, 
which  require  deep  penetration ;  for  this  purpose,  steam  is  to  be 
used.  It  has  no  injurious  action  on  metallic  substances,  woolen 
goods,  furs,  rubber  and  leather  articles,  colors  and  paintings.  It  is 
also  an  excellent  deodorant,  as  it  readily  combines  with  and  destroys 
the  foul-smelling  products  of  decomposition.  It  fails  to  kill  vermin 


DISINFECTION    AND   DISINFECTANTS. 


729 


and  is  of  but  little  value  even  against  mosquitoes,  unless  used  in 
large  amounts  in  tightly  closed  rooms.  (See  page  741.) 

Methods  of  Generation  and 
Use.  —  In  all  these  methods  (the 
third  excepted),  formaldehyde 
is  generated  from  formalin  and 
may  be  relied  upon  as  a  power- 
ful surface  disinfectant  under 
certain  conditions,  namely,  a  suf- 
ficiently high  temperature  and 
degree  of  humidity.  Below  60° 
F.,  formaldehyde  polymerizes 
into  paraform  and  has  but  little 
value.  In  the  absence  of  mois- 
ture it  is  practically  inert  as  a 
germicide;  for  satisfactory  re- 
sults the  relative  humidity  of  the 
air  of  the  room,  before  generat- 
ing the  gas,  must  be  at  least  60 
per  cent.  In  all  these  methods, 
about  the  same  amount  of 
watery  vapor  is  given  off,  but, 
for  disinfection  purposes,  this 
does  not  seem  to  answer  as  well 
as  the  natural  humidity  of  the 
atmosphere  (McClintic}.  Leak- 
age must  be  prevented  by  closing 
all  doors,  windows,  chimneys, 

ventilators  and  registers,  as  well  as  chinks  and  fissures,  using  paper 
strips  and  paste  very  freely  for  the  purpose :  sometimes  large 
paulins  or  ample  sheets  of  strong  paper  are  necessary.  Upon  the 
completion  of  the  process,  the  best  way  to  get  rid  of  the  gas  is  to 
open  all  the  doors  and  windows  and  let  it  blow  away.  Ammonia 
may  be  sprinkled  about  the  room  to  neutralize  it,  but  the  resulting 
substance  (formamid)  has  such  a  persistent  odor  that  this  is  now 
seldom  resorted  to. 

Of  the  many  methods  of  generating  formaldehyde,  the  most  prac- 
tical and  efficient  are : 

i.  With  Retort,   without  pressure.  —  Of   this   the   Trenner   Lee 


FIG.  241. —  Autoclave  formaldehyde 
generator. 


73O  MILITARY    HYGIENE. 

generator  is  a  good  type.  It  consists  of  a  copper  retort  from  which 
formalin  can  be  readily  and  conveniently  vaporized,  either  from  out- 
side or  inside  the  room,  without  pressure  and  automatically. 

2.  With  Autoclave,  under  pressure.  —  This  requires  a  somewhat 
complicated  apparatus,  not  free  from  danger,  and  only  used  from 
the  outside.     The  gas  is  very  quickly  liberated  under  a  pressure  of 
about  3  atmospheres.     To  the  formalin  should  be  added  20  per  cent, 
of  calcium  chloride  or  some  other  neutral  salt  to  prevent  polymeriza- 
tion and  facilitate  the  evolution  of  the  gas.     (Fig.  241.) 

3.  With  Generating  Lamp.  —  Of  this  the  Kuhn  generator  is  the 
best  type.     The  gas  is  obtained  by  the  oxidation  of  methyl  or  wood 
alcohol  brought  about  by  the  action  of  incandescent  platinized  asbes- 
tos, and  is  therefore  in  its  nascent  or  most  active  state.     The  pan 
containing  the  alcohol  is  surrounded  by  water  which  is  slowly  vapor- 
ized.    Three  pints  of  alcohol  are  required  to  disinfect  2,000  cubic 
feet  of  space.     One  of  the  disadvantages  of  this  lamp  is  that  the  gas 
is  generated  very  slowly  so  that  it  lacks  the  penetrating  power  of  the 
quicker  processes ;  but,  on  the  other  hand,  it  does  not  show  the  same 
tendency  to  polymerize  into  paraform.     (Figs.  242  and  243.) 

4.  Formalin-Permanganate  Method.  —  This  is  based  upon  the  fact 
that  when  formalin  is  poured  upon  potassium  permanganate,  a  vio- 
lent reaction  takes  place  with  strong  ebullition  of  the  mixture,  rapid 
generation  of  formaldehyde  and  considerable  vaporization  of  water. 
The  reaction  is  over  in  5  minutes  and  leaves  hardly  any  residue. 
The  average  yield  of  gas  is  81  per  cent,  of  the  amount  present  in  the 
solution.     The  best  proportion  of  formalin  and  permanganate  is  two 
to  one,  namely,  10  ounces  of  the  former  to  5  of  the  latter  for  each 
1,000  cubic  feet  of  space  if  the  atmosphere  is  warm  and  tolerably 
humid,  and  double  these  quantities  if  it  is  dry  and  cold.     On  account 
of  the  frothing  and  sputtering  which  occur,  the  permanganate  should 
be  put  in  a  tin  vessel,  10  inches  wide  at  bottom  and  about  18  inches 
high,  preferably  with  sides  flaring  out  toward  the  top.     This  vessel 
is  placed  in  a  shallow  tub  of  water,  or  simply  upon  a  piece  of  stout 
orown  paper  projecting  a  couple  of  feet  all  around  it  to  catch  the 
sputtering  drops  and  protect  the  floor.     Formaldehyde  being  inflam- 
mable care  must  be  taken  that  there  is  no  gas  jet  or  flame  of  any 
kind  in  the  room.     To  obtain  the  best  bactericidal  results  the  charge 
of  permanganate  in  any  one  vessel  should  not  exceed  200  grams. 

For  simplicity  and  rapidity  this  method  is  superior  to  any  other. 


DISINFECTION    AND   DISINFECTANTS.  731 

It  liberates  the  gas  almost  instantaneously  and  in  nearly  as  large 
quantities  as  the  retort  and  autoclave  methods  which  it  has  largely 
superseded.  No  advantage  is  gained  by  adding  water  to  the  formalin 
before  mixing  with  the  permanganate.  For  the  best  results  the 
temperature  of  the  room  should  not  be  less  than  65°  F. 


FIG.  242. —  Kuhn  formaldehyde       FIG.  243. —  Kuhn  formaldehyde  generator, 
generator.     Filling.     (Rosenau.)  Lighting.     (Rosenau.) 

5.  Sheet-spraying  Method.  —  For  each  1,000  cubic  feet  of  space, 
a  sheet  5  by  7  feet  is  hung  up  in  the  room  to  be  disinfected,  in  a 
slanting  position,  at  an  angle  of  about  45°.     It  should  be  wrung  out 
of  water  so  as  to  be  just  damp  to  the  touch  when  hung  up.     Three 
hundred  c.  c.   (about  10  ounces)    of  formalin  are  then  uniformly 
sprayed  upon  it,  so  that  the  small  discrete  droplets  will  not  run 
together.     The  room  must  be  tightly  sealed  and  kept  closed  at  least 
24  hours.     This  method  is  not  applicable  to  rooms  or  apartments  of 
a  much  greater  capacity  than  2,000  cubic  feet,  as  the  very  slow 
evaporation  from  the  sheets  would  not  be  equal  to  the  loss  from 
leakage.     It  is  fairly  efficient  when  long  exposure  is  not  objectionable 
and  the  weather  is  warm  (at  least  75°  F.)  or  the  house  artificially 
heated.     In  cold  weather  very  little  gas  is  liberated  and  it  quickly 
polymerizes. 

6.  With  Paraform.  —  Paraform  or  paraformaldehyde  is  a  poly- 


732  MILITARY    HYGIENE. 

meric  condensation  of  formaldehyde  gas.  It  is  a  white  powder, 
soluble  in  warm  water  and  burning  readily  with  a  blue  flame,  leaving 
no  residue  if  pure.  By  heating,  it  becomes  converted  into  its  own 
weight  of  formaldehyde,  but  should  not  be  allowed  to  burn  as  its 
combustion  practically  destroys  all  of  the  gas.  Special  lamps  have 
been  devised  for  the  volatilization  of  paraform,  but  an  ordinary  pint 
tin  cup  will  suffice  to  volatilize  an  ounce  or  two  of  paraform,  pro- 
vided the  flame  is  not  too  strong.  For  each  1,000  cubic  feet  of 
space,  2  ounces  of  paraform  should  be  used.  On  account  of  the 
simplicity  of  the  process,  requiring  only  a  sufficient  amount  of  an 
easily  transportable  powder,  this  method  seems  to  be  specially 
adapted  to  field  conditions. 

Candles  of  paraform,  prepared  by  reliable  firms,  are  now  in  the 
market  and  extensively  used. 

The  so-called  paraform-permanganate  method  has  been  found 
efficient  and  safe,  and  is  now  used  by  the  New  York  Department  of 
Health.  For  each  1,000  cubic  feet  of  space  the  proportions  are  as 
follows :  paraform  30  grams,  potassium  permanganate  75  grams, 
warm  water  90  grams.  The  two  chemicals  are  thoroughly  mixed 
in  a  small,  deep  tin  can  (pint  size),  then  the  water  is  added  and  the 
mixture  again  thoroughly  mixed.  The  evolution  of  gas  is  slow  in 
starting  but  is  practically  complete  in  5  to  10  minutes,  the  amount 
generated  running  as  high  as  87  per  cent.  There  is  no  sputtering 
and  no  danger  of  fire. 

7.  Munsoris  Method.* --The  apparatus  used  in  this  method  is 
described  as  "  of  simple,  light,  compact  and  inexpensive  character, 
by  which  gaseous  disinfection  of  the  equipment  of  the  soldier  in  the 
field  may  be  accomplished  in  as  short  a  time  as  20  minutes,  and  the 
destruction  of  insects,  vermin  and  parasites  thereon,  .  .  within 
half  that  time."  The  problem  consisted  in  finding  a  simple,  prac- 
tical and  effective  method  of  gas  disinfection  for  the  field,  and 
appears  to  have  been  solved  in  an  ingenious  and  successful  way, 
whereby  formaldehyde  is  applied  in  as  concentrated  a  form  as 
possible. 

The  generator,  of  copper  or  brass,  is  8  inches  high,  6  inches  in 
diameter  and  weighs  5  pounds.  It  consists  of  4  parts,  simple,  solid 
and  not  liable  to  injury  (Fig  244)  : 

*  The  Military  Surgeon,  February,  1913. 


DISINFECTION    AND   DISINFECTANTS. 


733 


i.  The  outer  container  (A),  a  cylinder  with  solid  bottom,  and 
two  perforations  at  opposite  points  near  the  top,  into  each  of  which 
is  screwed  a  short  tube.  One  of  these  tubes  is  provided  with  a 
turncock,  the  other  is  left  permanently  open  to  prevent  any  possi- 
bility of  explosion.  When  the  apparatus  is  used  inside  a  container, 
the  gas  escapes  through  both  openings ;  when  used  outside,  the 
turncock  is  closed  and  the  gas  forced  to  pass  through  the  other 
outlet. 


FIG.   244. —  Section   of    Munson's    disinfectant 
gas   generator. 

2.  The  cover  and  gas  bell  (B)  consisting  of  a  top  or  cap  held  in 
position  with  thumbscrews  and  perforated  to  receive  a  plunger ; 
from  the  under  surface  projects  a  cylinder  which  reaches  down 
within  half  an  inch  of  the  bottom  of  the  container,  and  intended  to 
prevent  spattering  and  the  escape  of  harmful  chemicals. 

3.  The  mixing  can  (C),  a  simple  cylinder  resting  in  a  frame  which 
raises  it  about  half  inch  above  the  bottom  of  the  container  to  permit 
free  movement  of  gas  and  prevent  overheating.     In  the  upper  rim 
are  grooves  for  the  arms  of  the  dosing  box. 


734  MILITARY    HYGIENE. 

4.  The  dosing  box  (D)  is  a  small  metal  receptacle  suspended 
within  the  mixing  can,  being  supported  by  four  arms  which  fit  in 
the  rim  of  the  latter.  The  bottom  is  hinged  in  such  manner  that  the 
plunger  (projecting  through  the  cap)  when  pressed  down  strikes 
against  it  and  causes  it  to  fall  open. 

In  operating  this  apparatus,  the  dosing  box  is  evenly  filled  with 
permanganate  (60  c.  c.),  and  formalin  poured  into  the  mixing  can 
until  the  mark  on  its  inside  is  reached  (150  c.  c.).  The  cover  being 
clamped,  the  apparatus  is  put  in  the  container,  if  to  be  operated 
inside,  or  connected  with  it  by  a  rubber  tube  if  to  be  operated  from 
outside.  The  plunger  is  pressed  down  so  as  to  drop  the  perman- 
ganate into  the  formalin,  and  the  reaction  started.  The  amount  of 
gas  thus  generated  will  be  sufficient  for  the  usual  disinfection  of 
1,000  cubic  feet  of  space.  The  quantity  of  the  chemicals  may  be 
reduced  as  desired. 

It  is  well  known  that  for  disinfection  purposes,  the  more  confined 
is  the  space  in  which  a  gas  is  generated,  and  the  more  free  from 
admixture  with  air,  in  other  words,  the  greater  its  concentration,  the 
more  efficient  is  its  action.  In  his  method,  Munson  avails  himself 
of  these  facts  by  using  a  collapsible  and  expansible  container,  one 
holding  very  little  air  in  its  collapsed  state  and  becoming  gradually 
distended  by  the  pure  gas  to  the  degree  desired.  This  concentration 
of  the  gas  greatly  increases  its  penetration  and  immensely  shortens 
the  factor  of  time  exposure.  Such  a  container,  in  the  shape  of  an 
impermeable  gas  bag,  is  readily  improvised  with  ordinary  rubber 
sheeting.  This,  as  furnished  by  the  Medical  Department,  comes  in 
rolls  54  inches  wide.  A  strip  6  feet  long  folded  on  itself  (rubber 
surface  outside)  makes  a  bag  sufficiently  capacious  to  hold  the  com- 
plete clothing,  blankets  and  equipment  of  two  soldiers,  together  with 
the  disinfecting  apparatus.  The  edges  are  pinned  or  stitched  to- 
gether and  holes  or  cracks  sealed  with  adhesive  plaster.  The 
soldier's  poncho,  or  ordinary  paper  bag  (especially  if  impermeable) 
may  also  be  utilized. 

A  great  advantage  of  this  method,  especially  when  the  apparatus 
is  placed  within  a  collapsible  container,  is  the  conservation  of  heat, 
so  that  the  hot  gas  does  not  polymerize,  and  carries  more  moisture. 

This  apparatus  is  also  well  fitted  for  use  in  rigid  containers,  such 
as  trunk,  box,  closet  or  room.  For  rooms,  a  larger  generator  (10^/2 
inches)  should  be  used. 


DISINFECTION    AND   DISINFECTANTS.  735 

The  conclusions  reached  from  the  results  of  many  experiments 
are  that  with  100  c.  c.  of  formalin  in  the  generator  and  the  use  of 
an  impermeable  collapsible  bag,  the  sterilization  of  bedding  and 
clothing  may  be  relied  upon  to  be  accomplished  in  20  minutes,  while 
insects  (bedbugs,  flies,  ants,  roaches,  etc.)  are  practically  always 
killed  in  15  minutes. 

8.  With  Steam  Chamber  and  Dry  Heat  in  Partial  Vacuum.  —  This 
method  requires  a  special  apparatus,  such  as  the  Kinyoun-Francis 
disinfecting  chamber  with  formaldehyde  attachment,  in  which  may 
be  obtained  a  high  percentage  of  formaldehyde,  a  temperature  of 
175°  F.  and  a  vacuum  of  15  inches.  The  attachment  consists  of  a 
copper  retort  (Fig.  241)  in  which  is  poured  a  formalin  mixture  (con- 
sisting by  volume,  of  formalin  5  parts,  calcium  chloride  i  part  and 
water  2  parts)  which  is  heated  by  means  of  a  copper  steam  coil.  It 
is  very  reliable,  quick,  not  destructive,  and  gives  good  penetration 
although  lacking  the  deep  penetrating  power  of  steam.  It  is  appli- 
cable to  baggage,  clothing,  household  effects,  and  especially  to  arti- 
cles liable  to  be  damaged  by  steam.  Letter  mail  is  rendered  safe 
by  this  process  without  puncturing  the  envelopes. 

To  operate  the  apparatus,  the  steam  is  first  turned  into  the  jacket 
and  the  chamber  heated  to  175°  F. ;  the  steam  ejector  is  then  set  to 
work  until  a  vacuum  of  15  inches  is  produced;  the  formaldehyde  is 
now  forced  in  from  its  retort  under  a  pressure  of  3  atmospheres. 
At  least  three  ounces  of  formalin  should  be  used  for  every  100  cubic 
feet.  The  size  of  the  retort  is  such  that  if  one-fifth  filled,  it  will 
entirely  saturate  the  chamber  with  gas,  one  liter  of  formalin  generat- 
ing about  1,450  liters  of  gas.  An  exposure  of  one  hour  is  ample  for 
thorough  disinfection.  At  the  completion  of  the  process  the 
formaldehyde  may  be  neutralized  by  ammonia  from  a  special  retort ; 
but,  according  to  Rosenau,  it  is  simpler  and  better  to  open  both 
doors  of  the  chamber  and  allow  the  gas  to  blow  away. 

Simple  Spraying.  —  Spraying  formalin  upon  walls,  floors  and  fur- 
niture is  always  an  excellent  additional  precaution  just  before  or 
after  the  application  of  any  of  the  methods  of  room  disinfection. 
Formalin  can  also  be  successfully  used  to  disinfect  contents  of 
trunks  and  boxes,  but,  for  this  purpose,  it  will  not  do  to  simply  pour 
it  into  the  corners;  it  should  be  carefully  sprayed  or  sprinkled  in 
small  drops  and  distributed  uniformly  between  the  layers,  using 
from  2  to  3  ounces  per  cubic  foot  (Rosenau). 


736  MILITARY    HYGIENE. 

Formalin-phenol  Method.  —  What  may  be  designated  by  this 
name  is  the  method  described  by  W.  B.  McLaughlin  who  showed 
that  if  formaldehyde  is  mixed  with  vapor  of  carbolic  acid  its  ten- 
dency to  polymerization  ceases,  while  its  power  of  penetration  is 
much  increase'd.  He  uses  a  mixture  of  75  parts  of  formalin  and  25 
parts  of  carbolic  acid,  8  ounces  of  which,  to  each  1,000  cubic  feet  of 
space,  are  volatilized  from  a  retort  or  sprayed  on  sheets.  By  this 
method,  resistant  strains  of  bacteria  were  killed  through  12  layers 
of  blankets,  under  conditions  where  formaldehyde  alone  would  not 
penetrate  3  layers. 

OZONE.  —  As  gaseous  disinfectant  of  rooms,  ozone  has  not  yet 
been  proved  practically  useful,  the  amount  produced  and  degree  of 
purity  varying  greatly  under  different  conditions.  It  has  undoubted 
antiseptic  power  but  only  in  such  concentration  (13  parts  per  million) 
as  is  by  no  means  innocuous.  According  to  Macfie  its  odor  is 
detectible  when  present  in  such  proportion  as  i  volume  in  2,500,000. 
As  little  as  i  per  million  is  irritating  to  the  respiratory  tract,  and  an 
exposure  of  two  hours  to  a  concentration  of  15  to  20  per  million  is 
not  without  danger  to  life. 

Ozone  is  more  or  less  successfully  used  for  the  sterilization  of 
water.  As  an  adjunct  to  ventilating  systems  it  is  claimed  to  be  a 
use'ful  deodorizer.  It  has  also  been  found  a  valuable  aid  in  the 
preservation  of  the  contents  of  cold-storage  rooms. 

DISINFECTING  AGENTS  IN   SOLUTION   OB  POWDER. 

Bichloride  of  mercury  or  mercuric  chloride,  popularly  known  as 
corrosive  sublimate,  is  the  most  powerful  of  all  metallic  salts  as  a 
disinfectant  under  favorable  conditions.  A  solution  of  i/iooo  is 
generally  stated  to  destroy  ordinary  bacilli,  free  from  spores,  in  a 
few  seconds.  Experimenters  differ  rather  widely  in  their  views  of 
its  efficiency,  but  it  is  evident  that  the  high  reputation  given  it  by 
former  observers  must  be  modified.  It  has  three  great  disadvan- 
tages :  it  is  virulently  poisonous,  corrodes  metals,  and  forms  with 
albumin  an  inert  insoluble  compound.  It  also  acts  as  mordant, 
permanently  staining  clothing  spotted  with  blood  or  pus.  Its  solu- 
tion, when  in  contact  with  certain  mineral  or  organic  substances,  is 
also  liable  to  precipitate  as  calomel,  sulphide  or  other  insoluble  com- 
pound. In  the  treatment  of  excretions,  for  instance,  such  as  sputum 
or  feces,  a  coagulum  of  albuminate  is  formed  on  the  surface  which 


DISINFECTION    AND    DISINFECTANTS.  737 

protects  the  innermost  bacilli  from  contact  with  the  disinfectant. 
This  may  be  prevented  by  the  addition  of  5  parts  of  acid  (sulphuric, 
hydrochloric  or  tartaric)  or  10  parts  of  common  salt  for  each  part  of 
sublimate.  For  use  in  infectious  diseases  (clothing,  floors,  walls, 
furniture,  etc.)  the  strength  of  the  solution  is  usually  i/iooo.  The 
solution  should  be  made  in  an  earthen  or  wooden  vessel.  The  addi- 
tion of  2  parts  of  common  salt  per  1,000  parts  of  water  renders  the 
bichloride  much  more  soluble.  According  to  Harrington,  a  solution 
of  i/ioooo  will  promptly  sterilize  certain  bacteria  when  their  re- 
sistance has  been  lowered  by  desiccation,  while  a  solution  of  1/5000 
is  ineffective  against  the  common  pathogenic  bacteria  in  a  moist  con- 
dition. According  to  the  same  authority,  even  i/iooo  solution 
requires  at  least  10  minutes  to  kill  some  of  the  commonest  of  the 
skin  bacteria,  so  that  it  would  be  of  advantage  to  abandon  its  use 
in  surgery. 

The  tablets  and  solutions  of  this  salt  are  generally  colored  with 
aniline  blue  or  some  other  neutral  dye  to  identify  them  and  prevent 
accidents. 

Mineral  acids  possess  decided  disinfecting  powers  and  may  be 
used,  largely  diluted,  wherever  their  corrosive  action  is  not  objec- 
tionable. A  solution  of  0.02  per  cent,  of  hydrochloric  acid  kills  the 
cholera  organism  in  2  hours,  and  one  of  0.07  per  cent,  the  bacillus  of 
typhoid  fever  in  the  same  time,  while  a  solution  of  0.08  per  cent,  of 
sulphuric  acid  will  sterilize  foul  sewage  in  15  minutes. 

Formalin,  a  40  per  cent,  solution  of  formaldehyde  already  de- 
scribed, is  extensively  used,  in  variable  degrees  of  dilution,  as  a  most 
valuable  disinfectant,  antiseptic  and  deodorant.  It  is  not  corrosive; 
articles  are  not  injured  by  it,  and  its  action  is  not  retarded  by  albu- 
minous matter.  A  solution  of  I  to  3,000  or  4,000  restrains  the 
growth  of  all  pathogenic  bacteria,  while  a  10  per  cent,  solution  mixed 
with  fecal  discharges  renders  them  odorless  at  once,  and  completely 
sterile  within  an  hour.  Tubercle  bacilli  in  sputum  are  killed  by  a 
5  per  cent,  solution  in  60  minutes.  Its  use  for  the  destruction  of 
flies  is  described  on  page  155.  Soiled  linen  and  bed  clothing  can  be 
disinfected  by  immersion  in  a  5  per  cent,  solution  for  one  hour. 
The  objection  to  formalin  is  the  irritating  gas  given  off  from  it, 
which  precludes  its  use  in  the  sick  room.  Occasionally,  in  suscep- 
tible people,  its  solution  may  cause  a  severe  dermatitis,  the  mere 
presence  of  the  vapor  in  the  room  producing,  in  such  people,  sting- 
ing formication  over  the  whole  surface  of  the  body. 


738  MILITARY    HYGIENE. 

Carbolic  Acid  (Phenol  or  Phenlc  Acid).  —  A  product  of  the  dis- 
tillation of  coal-tar.  When  chemically  pure  (phenol)  it  forms  white 
crystals  which  liquefy  by  the  addition  of  8  per  cent,  of  water.  This 
"  liquefied  phenol "  of  the  pharmacopoeia  dissolves  in  12  parts  of 
water,  while  the  so-called  pure  acid  of  commerce,  which  contains 
more  or  less  cresols,  dissolves  in  20  parts.  A  solution  of  3  to  5 
per  cent,  destroys  all  the  ordinary  pathogenic  bacteria  in  sputum 
and  excreta  in  a  few  hours.  As  it  does  not  injure  fabrics  nor  affect 
wood,  leather  or  metal,  its  range  of  application  is  very  great. 
Carbolic  acid  dissolved  in  alcohol  is  stronger  than  in  aqueous  solu- 
tion, but  loses  its  germicidal  properties  when  dissolved  in  oil. 

The  crude  acid,  which  is  the  form  generally  used  for  disinfection, 
contains  variable  amounts  of  cresols  and  other  similar  strongly  bac- 
tericidal bodies,  as  well  as  inert  tar  oils.  On  account  of  its  unre- 
liable strength  the  amount  used  should  be  at  least  equal  to  the 
volume  of  excreta. 

The  cresols  occur  as  impurities  of  carbolic  acid  and  are  generally 
combined  under  the  trade  name  of  "  tricresol."  They  are  about 
twice  as  powerful  as  carbolic  acid  and,  in  a  I  per  cent,  solution, 
promptly  destroy  the  pus-producing  organisms.  They  are  exten- 
sively used  under  many  preparations ;  being  insoluble  in  water  they 
are  combined  with  various  solvents  or  made  into  emulsions.  Of  the 
best-known  preparations  may  be  mentioned  lysol  and  creolin.  Lysol 
contains  about  50  per  cent,  of  cresols  dissolved  in  potash  soap ;  it  is 
fully  as  strong  as  carbolic  acid,  miscible  in  water  in  all  proportions, 
and  extensively  used  in  surgical  practice.  Creolin  is  a  dark  brown 
alkaline  liquid  containing  about  10  per  cent,  of  cresols.  These  prep- 
arations are  less  poisonous  and  less  irritating  to  the  skin  than  car- 
bolic acid  and  quite  as  potent  germicides. 

The  official  Liquor  cresolis  compositus  is  similar  to  lysol.  It  can 
be  extemporized  by  mixing  equal  weights  of  tricresol  and  official  soft 
soap  (/.  R.  Barber}. 

Chloride  '0/  lime  or  more  properly  chlorinated  lime,  is  a  white 
powder  of  somewhat  unstable  nature,  obtained  by  the  exposure  of 
water-slaked  lime  to  nascent  chlorin  gas.  To  be  efficient  it  must 
contain  at  least  25  per  cent,  by  weight  of  chlorin.  As  it  readily 
undergoes  decomposition,  it  should  be  kept  in  tight  vessels  in  a  cool 
and  dry  place.  Its  composition,  although  still  uncertain,  is  generally 
considered  to  be  a  mixture  of  calcium  chloride  and  calcium  hypo- 


DISINFECTION    AND   DISINFECTANTS.  739 

chlorite.  It  is  an  effective  disinfectant  in  a  solution  of  5  per  cent. 
or  even  less.  A  solution  is  best  made  by  triturating  the  requisite 
amount  in  water  to  the  consistency  of  cream  and  then  diluting  to  the 
required  volume.  Chlorinated  lime  corrodes  metals,  but  its  action 
upon  agate  ware  is  very  slight.  It  also  bleaches  and  otherwise  in- 
jures fabrics.  It  is  useful  for  the  disinfection  of  excreta  and 
sputum,  the  mopping  of  floors  and  the  washing  of  hands.  It  is  com- 
monly used  as  a  deodorant  on  account  of  its  great  affinity  for  hydro- 
gen, readily  decomposing  hydrogen  sulphide,  ammonia  and  other 
volatile  odorous  substances.  It  must  be  remembered,  however,  that 
its  own  odor  is  often  quite  objectionable. 

Chlorinated  lime  is  extensively  used  on  the  battlefields  of  Europe 
in  the  treatment  of  infected  wounds,  after  proper  neutralization 
with  anhydrous  sodium  carbonate  and  sodium  bicarbonate  according 
to  the  method  of  Dakin.  The  proportion  of  these  two  salts  varies 
according  to  the  titration  of  the  chlorinated  lime.  With  a  titration 
of  30,  the  quantities  of  the  three  substances  required  to  prepare  10 
liters  of  Dakin's  solution  would  be  154  gms.  of  chlorinated  lime,  77 
of  anhydrous  sodium  carbonate  and  64  of  sodium  bicarbonate.* 

Quicklime  or  calcium  oxld  is  an  excellent  disinfectant  well  adapted 
to  military  needs.  Treated  with  about  one-half  its  weight  of  water, 
it  evolves  considerable  heat  and  becomes  *  hydrated  or  "  slaked." 
"  Milk  of  lime  "  is  made  by  thoroughly  mixing  slaked  lime  with 
from  4  to  8  parts  of  water.  If  more  water  is  added,  the  familiar 
"  white  wash  "  is  obtained.  Lime  dissolves  in  700  parts  of  water, 
yielding  a  clear  solution  which  is  "  lime  water."  When  exposed  to 
the  air,  quicklime  is  rapidly  acted  upon  by  carbon  dioxid,  and  most 
of  it  becomes  changed  into  carbonate  which  is  practically  inert ; 
hence  the  necessity  of  always  using  freshly  burned  and  slaked  lime. 

Lime  has  been  proved  to  be  a  strong  and  reliable  disinfectant, 
especially  in  the  treatment  of  fecal  discharges ;  it  can  be  used  as  dry 
powder,  after  partial  slaking,  but  fresh  milk  of  lime,  of  15  to  20  per 
cent,  strength,  is  preferable.  At  least  as  much  should  be  added  as 
the  bulk  of  matter  to  be  disinfected,  and  thoroughly  mixed  with  it ; 
in  this  way  complete  sterilization  may  be  expected  in  an  hour  or  two. 
It  is  probable  that  lime  of  good  quality  is  very  nearly,  if  not  quite, 
as  good  a  disinfectant  as  the  average  chloride  of  lime,  while  it  is 

*  Carrel's  Method  of  H'onnd  Sterilization.  Colonel  W.  H.  Arthur.  The 
Military  Surgeon,  May,  1917. 


74O  MILITARY    HYGIENE. 

much  cheaper  and  odorless.  Whitewashing  the  walls  of  barracks, 
cellars,  store-rooms  and  outbuildings  is  an  excellent  practice;  for 
this  purpose  chloride  of  lime  can  often  be  advantageously  mixed 
with  the  lime.  The  sprinkling  of  dry  powdered  lime  on  infected 
soil,  or  soil  liable  to  be  infected,  as,  for  example,  around  the  edges 
of  latrines,  along  picket  lines,  or  in  the  vicinity  of  kitchens,  laundries 
and  lavatories,  is  always  advisable  and  often  necessary. 

The  basic  Fuchsins,  soluble  in  water  and  alcohol,  possess  (accord- 
ing to  E.  S.  May)  a  marked  germicidal  action.  Especially  great  is 
the  disinfectant  power  of  rosanilin  acetate  (the  most  basic  of  them), 
exceeding  that  of  phenol,  with  greater  diffusibility  and  less  toxicity. 

Ferrous  sulphate,  also  called  sulphate  of  iron  or  copperas,  occur- 
ring in  green,  efflorescent  crystals,  has  been  extensively  used  as  a 
deodorant,  especially  for  the  removal  of  odors  from  privies  and 
vaults.  It  is  useless  as  a  disinfectant  and  has  very  little  claim  to  be 
considered  even  a  deodorant. 

ROOM   DISINFECTION. 

So  long  as  a  room  is  occupied  by  the  patient,  disinfection  is  impos- 
sible, but  every  effort  should  be  made  to  prevent  the  dissemination 
of  infectious  material ;  to  that  end  the  rules  to  be  observed  are  thus 
comprehensively  formulated  by  Harrington  :* 

"  In  order  to  prevent  or  restrict  the  carriage  of  living  organisms 
from  the  room,  ingress  should  be  denied  to  all  whose  presence  is  un- 
necessary ;  the  wearing  of  other  than  cotton  and  linen  dresses,  that 
is,  smooth-surfaced  and  washable,  by  the  attendants  should  be  inter- 
dicted ;  no  food  remainder  should  be  taken  away  to  be  consumed  by 
others ;  no  used  bed-linen  or  body-linen  removed  until  after  immer- 
sion in  disinfectant  solutions,  and  no  discharges  finally  disposed  of 
until  after  appropriate  treatment.  If  it  be  necessary  to  use  the 
broom,  the  dust  should  be  kept  down  by  the  use  of  wet  sawdust  or 
tea  leaves,  which,  with  the  gathered  dirt  and  dust,  should  be  treated 
with  disinfectant  and  burned." 

In  any  case  of  infectious  sickness,  all  linen  used  in  the  room  and 
liable  to  have  been  infected  must  be  thrown  into  a  tub,  immersed  for 
an  hour  in  a  disinfecting  solution  and  then  carried  under  cover  on 
wrapped  in  a  disinfected  sheet  to  the  laundry.  The  solution  may  be 

*  Manual  of  Practical  Hygiene,  Charles  Harrington.     1905. 


DISINFECTION    AND   DISINFECTANTS.  741 

of  corrosive  sublimate  (1/1000),  carbolic  acid  (5/100),  cresol 
(3/100),  or  formalin  (4/100).  Chlorinated  lime  is  liable  to  injure 
fabrics  and  therefore  not  suitable  for  this  purpose.  All  eating  uten- 
sils should  be  well  scalded  after  meal,  each  patient  having  his  own 
set,  not  to  be  used  by  anybody  else.  • 

For  the  disinfection  of  rooms,  formaldehyde  gas  combines  more 
of  the  requirements  of  the  ideal  disinfectant  than  any  other  so  far 
tried,  and  is  now  almost  exclusively  used  for  the  purpose.  But  all 
hygienists  recognize  that  the  complete  destruction  of  bacteria  in  an 
infected  room,  by  the  application  of  any  gas,  is  extremely  difficult, 
generally  impossible,  and  that  the  result,  although  undoubtedly  use- 
ful, is  nearly  always  imperfect.  It  is  necessary  therefore  to  have 
recourse  to  supplementary  measures  before  and  after  the  application 
of  the  gas.  In  the  first  place,  if  a  steam  sterilizer  be  available,  mat- 
tresses, pillows  and  stuffed  articles  should  be  removed  (wrapped  in 
disinfected  sheets)  and  treated  in  it.  If  the  stuffing  be  of  inexpen- 
sive material  it  is  best  to  burn  it,  while  the  ticking  can  be  disinfected 
and  boiled.  The  contents  of  the  room  should  be  so  arranged  as  to 
be  easily  reached  by  the  gas  on  all  sides :  articles  of  furniture  moved 
away  from  the  walls,  clothing  and  bedding  suspended  on  lines,  pock- 
ets turned  inside  out,  and  drawers  of  all  bureaus  and  cabinets  left 
open.  The  careful  closing  of  all  openings  and  sealing  of  all  cracks 
and  fissures  has  already  been  dwelt  upon. 

After  the  fumigation,  the  carpets  and  hangings  should  be  exposed 
to  the  sunlight  and  beaten ;  the  floors  must  be  scrubbed  with  a  solu- 
tion of  chloride  of  lime  (i/ioo)  or  of  corrosive  sublimate  (1/2000), 
and  the  walls  sprayed  with  the  same  or,  still  better,  a  solution  of 
formalin  (5/100).  Should  the  walls  be  covered  with  soiled  and 
cracked  paper,  it  is  best  to  remove  it  so  that  they  may  be  rekalso- 
mined  and  new  paper  put  on.  All  woodwork  and  articles  of  furni- 
ture not  liable  to  be  injured  thereby  should  be  washed  with  soft  soap 
and  hot  water,  followed,  if  deemed  necessary,  by  formalin  spray. 

The  experiments  and  observations  of  Chapin  and  others  have 
lately  considerably  modified  our  views  of  the  necessity  of  terminal 
disinfection,  that  is,  the  disinfection  of  rooms  and  their  contents 
after  the  recovery  of  infectious  cases.  Attention  has  been  more 
forcibly  drawn  to  the  already  recognized  facts  that  the  danger  is 
chiefly  from  infected  persons  and  not  from  infected  things ;  that 
pathogenic  germs  do  not  grow  outside  of  the  body  and  soon  perish, 


742  MILITARY    HYGIENE. 

or  at  least  soon  lose  their  virulence.  Thus,  pus-forming  bacteria  are 
often  found  in  the  air  of  operating  rooms,  but  surgeons  no  longer 
sterilize  the  air.  Extension  of  infection  usually  takes  place  by  im- 
mediate or  mediate  contact  with  convalescents  or  "  carriers."  The 
belief  in  transmission  by  fomites  or  through  aerial  germs  never  had 
but  the  flimsiest  basis  in  observation  or  experiment.  There  is  little 
doubt  that  transmission  may  be  effected  by  mediate  contact,  that  is, 
the  transfer  of  fresh  infective  material  on  inanimate  objects.  This 
is  best  combated  by  scrupulous  cleanliness  in  the  care  of  patients, 
the  free  use  of  soap  and  water,  and  frequent  washing  of  the  bed 
linen  and  clothing. 

In  practice,  it  has  been  found  that  the  results  of  compulsory  ter- 
minal disinfection  in  preventing  the  spread  of  infectious  diseases  are 
not  better  than  where  such  disinfection  is  omitted.  As  a  conse- 
quence of  this  new  trend  of  medical  opinion,  much  less  importance 
is  now  attached  to  the  fumigation  of  room  and  fomites,  and  much 
more  to  the  scrubbing  of  floors  and  the  mopping  of  walls  and 
furniture. 

Cleaning  of  the  hands  is  frequently  necessary  in  the  nursing  of 
infectious  diseases.  Under  such  conditions  disinfectants  injure  the 
skin  and  should  be  used  as  little  as  possible.  Bearing  in  mind  that 
soap  has  decided  germicidal  properties,  the  process  should  always 
begin  witk  soap  and  warm  water,  not  in  a  basin  but  under  a  tap,  in 
running  water,  followed  or  not  by  immersion  in  alcohol.  When  a 
stronger  effect  is  desired  the  hands  may  be  immersed  in  a  3  per  cent, 
solution  of  formalin,  carbolic  acid,  cresol  or  lysol. 

DISINFECTION  IN  THE  FIELD.  —  Even  when  troops  are  so  situated 
as  to  be  deprived  of  the  usual  modern  sanitary  appliances,  practical 
means  of  disinfection  are  never  entirely  wanting  and  should  not  be 
neglected.  Exposure  to  sunlight  and  wind,  as  well  as  boiling,  are 
generally  possible  and  always  efficient.  Of  chemical  disinfectants 
for  use  in  the  field,  light,  compact,  safely  and  easily  transported,  the 
best  two  appear  to  be  mercury  bichloride  and  paraform.  Any  tent 
which  needs  disinfection  should  be  turned  inside  out,  scrubbed  with 
a  bichloride  solution  and  repitched  on  new  ground,  exposed  to  sun 
and  wind.  The  original  tent  area  is  covered  with  straw  and  fired. 
Whenever  clothing  or  other  articles  need  disinfection,  other  than 
boiling,  a  formaldehyde  chamber  is  readily  improvised,  a  large  pack- 
ing box  being  utilized  for  the  purpose,  covered  over  with  a  tarpaulin 


DISINFECTION    AND   DISINFECTANTS.  743 

or  tent  fly  to  prevent  leakage,  and  the  gas  produced  by  the  volatili- 
zation of  paraform.  The  Munson  method  of  using  formaldehyde 
(see  p.  732)  is  especially  applicable  to  field  conditions,  provided  the 
chemicals  are  at  hand.  Another  useful  disinfectant,  lime,  can  also 
be  procured  in  most  situations,  or  at  least  wherever  limestone  is 
found  in  sufficient  quantity. 

For  disinfection  of  ships,  see  Marine  Hygiene. 

Disinfection  of  Feces.  —  The  fecal  discharges  in  typhoid  fever, 
dysentery  and  cholera,  as  often  stated,  contain  most  of  the  excreted 
infectious  germs  and  therefore  must  be  carefully  treated.  The 
amount  of  disinfectant  should  be  at  least  equal  to  that  of  the  dis- 
charges, thoroughly  mixed  with  them  and  allowed  to  stand  for  about 
an  hour  before  final  disposal.  Formalin  (5/100)  is  best  for  the 
purpose.  Milk  of  lime  is  too  bulky  for  water-closets  but  very  useful 
in  camps.  Chloride  of  lime,  carbolic  acid  and  the  cresols  are  also 
effective  and  may  be  used  whenever  the  odor  is  not  found  objection- 
able. In  typhoid  fever,  the  urine  should  be  disinfected  with  about 
a  twentieth  of  its  volume  of  formalin. 

Disinfection  of  Sputum.  —  In  tuberculosis  and  pneumonia,  special 
individual  spit-cups  should  be  used,  partly  filled  with  disinfectant 
and  kept  covered.  A  5  per  cent,  solution  of  carbolic  acid,  or  4  per 
cent,  of  cresol  or  formalin,  is  best  for  the  purpose.  Paper  spit-cups, 
which  are  afterwards  thrown  into  the  fire,  are  still  better.  The  dis- 
charges from  the  mouth  and  nose  in  diphtheria,  tonsillitis,  whooping- 
cough  and  cerebrospinal  meningitis  should  be  received  in  rags  and 
burned. 


CHAPTER  LX. 

HYGIENE  OF  THE  BATTLEFIELD. 

The  soldier,  in  presence  of  the  enemy,  and  with  a  battle  impend- 
ing, must  bear  in  mind  the  value  of  certain  precautions  which, 
should  he  be  wounded,  will  greatly  tend  to  prevent  a  fatal  issue  and 
hasten  his  recovery. 

1.  Let  him  make  sure  that  he  has  a  first-aid  packet,  as  required  by 
the  Field  Service  Regulations,  that  it  is  in  good  condition  and  that 
he  knows  how  to  apply  it.     This  is  of  prime  importance  for  he  may 
thus  be  able  to  save  his  own  life  or  that  of  a  comrade.     Inasmuch 
as  a  wound  always  stands  in  danger  of  infection  from  the  clothing, 
the  prompt  application  of  an  aseptic  dressing  gives  the  patient  much 
better  chances  of  escaping  dangerous  complications. 

2.  Let  him  fill  his  canteen  with  boiled  water  or  as  good  water  as 
can  be  procured,  whenever  the  opportunity  offers,  for  he  does  not 
know  how  long  it  may  be  before  a  new  supply  is  available.     If 
wounded,  especially  in  case  of  free  hemorrhage,  he  will  be  tormented 
with  thirst.     Should  he  escape  injury,  he  may  be  able  to  quench  the 
thirst  of  a  less  fortunate  comrade. 

3.  Let  him  be  as  clean  in  body  and  clothing  as  circumstances  per- 
mit, washing  himself  with  a  wet  towel  if  a  bath  is  impossible,  and 
changing  his  underclothing.     The  value  of  this  precaution  is  obvious 
in  view  of  the  preponderant  part  played  by  skin  and  clothing  in  the 
infection  of  wounds. 

4.  Let  him  see  to  it  that  his  bowels  have  moved  freely  and  that 
his  bladder  is  empty.     This  is  in  order  to  mitigate  the  danger  of 
urine  and  fecal  extravasation  in  case  of  abdominal  injury.     For  the 
same  reason,  his  food  should  be  nourishing  in  small  bulk,  and  eaten 
in  moderation. 

5.  If  gravely  injured,  or  exsanguined,  it  will  generally  be  the 
better  course  for  the  soldier  (in  a  war  with  a  civilized  enemy)  to 
remain  quietly  recumbent  where  he  fell,  or  at  the  nearest  shelter, 
until  rescued  by  the  litter-bearers,  either  of  his  own  side  or  of  the 
enemy.     Any  great  effort  to  walk  may  aggravate  the  injury  and 
jeopardize  life. 

744 


HYGIENE   OF  THE   BATTLEFIELD.  745 

There  are  prominent  features,  in  modern  warfare,  of  special 
interest  to  the  military  hygienist.  The  most  striking  is  the  enor- 
mous extension  of  the  battle  line,  requiring  the  calling  to  arms  or 
other  military  duties  of  all  able-bodied  men.  In  the  Russo-Japanese 
War  of  1904-1905  the  battle  line  had  already  reached  a  length  of 
85  to  90  miles,  but  at  this  writing  (1917)  the  western  front  of  the 
belligerent  armies  in  Europe  is  over  400  miles,  while  their  eastern 
front  is  more  than  twice  as  long.  Let  this  be  compared  with  the 
battle  line  of  Waterloo,  3  or  4  miles  long,  or  that  of  Antietam  and 
of  Gettysburg,  4  or  5  miles  long. 

This  tactical  disposition  of  troops  in  thin,  long-drawn-out  lines, 
has  the  excellent  effect,  from  the  viewpoint  of  hygiene,  of  prevent- 
ing large  massing  of  troops,  thus  reducing  to  a  minimum  the  risk 
of  transmitting  infectious  diseases  and  making  serious  outbreaks 
practically  impossible  along  the  front.  The  danger  will  lie  further 
in  rear,  in  camps  of  concentration  and  instruction  where  the  active 
efforts  of  medical  officers  in  preventing  the  incidence  and  spread  of 
disease  will  save  many  more  lives  and  contribute  much  more  effi- 
ciently to  maintain  the  strength  of  the  combatant  units,  than  in 
tending  the  wounded  on  the  battlefield. 

Another  amazing  feature  of  war  is  the  leading  part  taken  by  the 
aeroplane,  the  new  war  engine  that  carries  death  and  destruction 
many  miles  in  rear  of  the  fire  zone  and  ascertains  the  movements 
of  the  enemy  so  as  to  render  surprises  almost  impossible.  It  is 
especially  a  serious  menace  to  camps  under  canvas  and  will  tend 
more  and  more  to  drive  troops  under  ground  or  in  otherwise  incon- 
spicuous shelters. 

Also  very  remarkable  is  the  protracted  duration  of  campaigns; 
they  have  ceased  to  be  "  short  and  decisive."  Battles  consist  of 
series  of  engagements  covering  days  and  weeks.  Field  intrench- 
ments  are  used  to  an  extent  never  known  before,  so  that  the  soldier 
at  the  front,  except  when  charging,  is  hidden  in  trenches  and  invis- 
ible to  the  enemy.  Advances  are  slow  and  must  be  prepared  by 
several  days  of  terrific  artillery  fire.  When  of  about  equal  strength, 
the  belligerents  may  remain  in  their  positions,  confronting  each 
other,  for  weeks,  without  any  decisive  movement  forward  or  back- 
ward. Under  these  circumstances,  underground  works  such  as 
trenches,  dugouts,  galleries,  magazines,  dressing-stations,  etc.,  soon 
assume  much  importance. 


746  MILITARY    HYGIENE. 

This  comparative  immobility  of  the  battle  line  should  be  taken 
advantage  of  to  promote  the  comfort  and  health  of  the  men.  It 
will  probably  be  possible  then  to  supply  fresh  bread  and  needful 
components  of  the  field  ration,  as  well  as  to  issue  clothing.  Medical 
officers  will  be  able  to  bring  up  supplies,  and  to  give  serious  cases 
suitable  treatment  before  their  transportation  to  the  rear.  In  case 
of  retreat  they  will  probably  also  have  time  to  take  measures  for  a 
safe  and  orderly  evacuation. 

Season  and  weather  may  cause  an  occasional  lull  in  the  fighting 
but  no  serious  interruption  of  a  campaign.  The  Manchurian  War 
of  1904-5  and  the  present  European  War  have  shown  the  possi- 
bility of  carrying  on  a  winter  campaign  and  fighting  decisive  battles 
with  the  temperature  at  about  zero  F.  without  many  casualties  from 
congelation  and  frost-bite.  This  had  already  been  shown  in  some 
of  our  Indian  campaigns  but  never  on  the  same  scale  nor  with  the 
same  convincing  effect.  With  head  and  extremities  suitably  pro- 
tected, a  severe  degree  of  cold,  even  below  zero,  does  not  appear  to 
have  an  important  inhibitive  effect  on  the  efficiency  of  the  soldier. 

Of  all  the  great  developments  of  the  several  branches  of  military 
science,  the  most  momentous  in  its  effects  is  that  achieved  by  the 
artillery,  in  the  increased  number  and  power  of  pieces  and  the 
wonderful  accuracy  of  their  fire.  The  result  is  a  much  larger  pro- 
portion of  wounds  from  shrapnel  and  shell  fragments  than  ever 
before  —  mostly  extensive  and  lacerated  wounds  of  great  gravity  — 
and  a  decidedly  higher  rate  of  killed  to  the  wounded. 

Trench  Hygiene.  —  Trench  warfare,  with  all  its  accompaniments 
of  underground  shelters,  constitutes  a  sanitary  problem  which  al- 
ways calls  for  the  best  judgment  and  greatest  ingenuity  of  the 
medical  officer.  The  dead  and  wounded  may  encumber  the  trenches, 
and  their  removal  made  impossible,  sometimes  for  days,  by  the  con- 
tinuity of  bursting  shells,  or  if  possible,  very  difficult  by  reason  of 
the  size  of  the  stretcher  and  the  many  obstacles  in  the  way  of  the 
bearers.  The  disposal  of  excreta,  garbage  and  dirt  in  trenches  and 
dugouts  may  present  many  difficulties  and  should  receive  constant 
medical  supervision  in  order  to  avoid  offensive  and  dangerous  accu- 
mulations. It  is  in  crowded  dugouts  that  the  transmission  of  disease 
by  contact  is  most  to  be  apprehended.  Fortunately,  cooking  is 
seldom  necessary  in  the  front  trenches,  the  food  being  brought  from 
the  rear  through  connecting  galleries  or  boyaux,  so  that  the  usual 
kitchen  wastes  are  avoided. 


HYGIENE   OF   THE    BATTLEFIELD.  747 

In  case  of  rain  the  discomfort  of  the  men  is  greatly  increased. 
If  the  drainage  is  bad,  as  often  happens,  they  may  be  obliged  to 
stand  for  hours  in  water  and  mud,  a  situation  tending  to  produce 
what  has  been  called  "  Trench  Foot  "  (page  121). 

The  disposal  of  excreta  is  generally  by  the  bucket  system  or  by 
the  straddle  trench.  The  bucket  system  is  seldom  satisfactory,  as 
the  receptacle  is  quite  likely  to  be  emptied  into  a  near  shell  crater 
or  other  improper,  place;  in  the  absence  of  water  its  thorough  clean- 
ing and  disinfection  may  be  impossible.  The  straddle  trench  is 
effective  provided  it  is  frequently  inspected.  Box  latrines,  if  suit- 
able material  be  at  hand,  may  also  be  used  to  advantage.  Garbage 
and  refuse  should  only  be  deposited  at  designated  and  marked  places, 
and  are  carried  out  to  be  burned  or  buried  whenever  possible. 

In  trenches,  soldiers,  although  often  placed  in  an  environment 
more  or  less  polluted  by  the  domestic  wastes  of  generations,  are 
unable  to  bathe  and  wash  and,  for  a  number  of  days,  to  change 
their  clothing.  The  result  is  an  inevitable  accumulation  of  dirt  upon 
the  clothing  and  upon  the  skin,  a  dirt  often  rich  in  pathogenic  and 
septic  germs.  The  effect  of  such  environment  is  that  all  wounds 
are  infected,  excepting  perhaps  a  small  proportion  of  those  inflicted 
with  the  rifle.  Always  and  severely  infected  are  the  large,  torn 
wounds  made  by  artillery  projectiles  and  grenades.  During  the  first 
part  of  the  European  War,  tetanus  and  gas  gangrene  were  frequent 
complications  of  wounds,  but  antitetanic  serum  and  the  surgeon's 
skill  have  largely  overcome  them. 

Trench  warfare  offers  some  advantages  from  the  surgeon's  view- 
point. It  facilitates  first-aid  treatment ;  the  wounded  can  often  be 
carried  out  of  the  danger  zone  without  risk  from  the  enemy's  fire. 
It  is  also  possible,  in  abdominal  and  other  urgent  wounds,  to  operate 
at  once  in  a  suitably  equipped  dugout,  thus  saving  patients  from  the 
peril  of  long  and  rough  transportation. 

From  what  is  known  of  the  life  of  soldiers  at  the  front,  much  of 
the  time  in  trenches  and  ill-smelling  dugouts,  with  depressing  en- 
vironment and  exposed  to  all  changes  and  extremes  of  weather,  one 
would  naturally  infer  that  their  health  would  undergo  gradual 
deterioration.  But  it  is  pleasant  to  realize  that  the  contrary  is  true. 
Official  reports  from  the  French,  English  and  German  headquarters 
show  that  there  has  been  a  steady  improvement  in  health,  vigor  and 
resistance  to  fatigue  and  disease  in  all  men  who  have  served  at  the 


748  MILITARY    HYGIENE. 

front  during  the  last  2  or  3  years.  Alarming  accounts  have  been 
circulated  of  a  great  increase  of  tuberculosis  among  soldiers  as 
result  of  camp  and  trench  life,  but  such  reports  are  positively  denied 
by  competent  observers.  Sir  William  Osier,  in  1916,  stated  that 
"  of  1,000,000  enlisted  men  between  the  ages  of  18  and  40,  the  pro- 
portion to  develop  tuberculosis  is  probably  much  smaller  than  if 
these  men  had  remained  in  civil  life." 

Subsequent  experience  has  confirmed  his  statement. 

A.  M.  Fauntleroy,  of  the  U.  S.  Navy,  after  careful  observations 
behind  the  allied  armies,  reports  that  "  tuberculosis  of  the  lungs  is 
of  rather  infrequent  occurrence." 

The  100,000  tuberculous  discharged  soldiers  in  France,  at  present, 
do  not  represent  a  higher  percentage  of  that  disease  than  could  be 
expected  in  that  country  under  modern  normal  conditions.  Accord- 
ing to  Prof.  Fishberg,*  figures  published  by  Renon  show  clearly  that 
tuberculosis  has  not  increased  in  the  population  of  France  since  the 
war  began. 

We  may  conclude  that,  in  favor  of  the  able-bodied  soldier  at  the 
front,  there  are  factors  which  make  for  strength  and  vitality,  well- 
known  factors  indeed  but  deserving  to  be  again  mentioned,  namely : 

A  life  in  conformity  with  intelligent  regulations,  and  free  from 
all  excesses;  moderate  (often  scant)  and  wholesome  diet;  reduc- 
tion or  suppression  of  alcoholic  drinks ;  free  exposure  to  open  air 
day  and  night;  active  exercise,  including  much  hard  work  and 
many  hardships. 

After  the  Battle.  —  The  duties  of  medical  officers  generally  be- 
come more  strenuous  toward  the  close  of  the  battle.  Upon  them 
rests  the  responsibility  of  collecting,  transporting  and  treating  the 
wounded,  of  recommending  and  superintending  the  proper  disposal 
of  the  dead  and  of  all  that  relates  to  the  sanitation  of  the  battlefield. 

The  search  for,  and  collecting  of  the  wounded  and  the  dead  may 
prove  to  be  arduous  work  when  the  fighting  has  taken  place  through 
broken  grounds,  woods,  brush  and  crops,  and  every  available  help 
should  be  secured.  Trained  dogs  have  proved  invaluable  for  that 
purpose  and  are  kept  in  most  of  the  European  armies  ready  for 
use,  an  example  worthy  of  our  imitation.  Inasmuch  as  the  search- 
ing must  often  be  carried  on  at  night,  it  is  important  to  provide  a 

*  Tuberculosis  and  War.     Maurice  Fishberg.    Jour.  A.  M.  A.,  June  16, 1917. 


HYGIENE   OF   THE   BATTLEFIELD.  749 

suitable  system  of  illumination.  Experience  has  shown  the  superi- 
ority of  acetylene  lamps  for  the  purpose,  not  powerful  searchlights 
which  project  impenetrable  shadows  behind  every  bush  and  hillock, 
but  small  portable  lights  carried  in  the  hand,  at  the  waist  or  the 
hat  band  of  the  litter-bearer. 

Disposal  of  the  Dead.  —  The  disposal  of  the  dead  is  a  serious 
question,  whether  viewed  from  the  humanitarian  or  sanitary  stand- 
point, and  an  important  duty  devolving  upon  the  belligerent  that 
remains  in  possession  of  the  field.  "  The  dead  are  collected  by 
details  from  the  line  as  soon  as  practicable  after  the  battle  and  dis- 
posed of  as  the  commander  directs.  No  body  is  buried  or  otherwise 
disposed  of  without  being  identified  and  a  proper  record  made." 
(F.  S.  R.)  These  details  should  be,  so  far  as  possible,  from  the 
regiments  actually  engaged  in  the  battle,  therefore  having  a  knowl- 
edge of  the  battlefield  and  better  able  to  find  and  identify  the  bodies. 
The  natural  claims  of  humanity  demand  this  identification  in  civil- 
ized warfare  whenever  practicable ;  to  those  who  die  in  its  defense, 
the  country  owes  the  duty,  at  least,  to  preserve  their  names  and 
mark  the  place  of  their  burial.  The  Geneva  Convention  also  re- 
quires that  the  enemy's  dead  should  be  collected,  carefully  examined 
and  buried. 

"  Before  a  command  enters  upon  a  campaign,  every  member 
thereof  is  provided  with  an  identification  tag  by  which  he  -can  be 
identified  if  killed  or  wounded.  Regimental  and  other  commanders 
are  charged  with  seeing  that  their  commands  are  provided  with 
these  tags  in  ample  time,  and  that  they  are  properly  worn.  They 
are  not  removed  from  the  dead,  but  left  on  the  bodies  when  interred 
or  otherwise  disposed  of."  (F.  S.  R.}  The  tag  is  worn  under 
the  shirt,  suspended  from  a  cord  around  the  neck.  Being  of  durable 
metal  it  will  last  as  long  as  the  skeleton  of  the  body  so  that  the  re- 
mains can  be  identified  if  exhumed  at  any  later  date.  Tags  or  other 
marks  of  identification,  as  well  as  valuables,  found  on  dead  bodies 
of  the  enemy  are  turned  over  to  the  commander  of  trains,  who 
sends  them  to  the  provost  marshal  at  the  base. 

Two  general  methods  of  disposal  of  the  dead  may  be  used,  namely, 
burial  and  cremation.  The  latter  method  is  seldom  practicable  on 
the  battlefield  nor  is  it  generally  desirable.  For  obvious  reasons 
the  preservation  of  remains  is  preferable:  it  permits  their  identifi- 
cation at  any  subsequent  time,  and  their  transfer  to  the  family  plot 


75O  MILITARY    HYGIENE. 

or  national  cemetery.  But  there  are  circumstances  when  cremation 
imposes  itself ;  for  instance,  in  case  of  a  siege,  where  space  for  burial 
is  not  available,  or  again  when  the  soil  is  so  rocky  or  so  hard  frozen 
that  graves  cannot  be  dug  with  means  at  hand ;  it  is  also  the  better 
method  to  dispose  of  the  bodies  of  men  dead  from  acutely  infectious 
diseases,  like  plague,  cholera,  smallpox. 

The  bodies  must  be  carefully  examined  to  make  sure  that  life  is 
extinct.  As  probably  several  hours,  perhaps  a  day  or  two,  will  haue 
passed  since  death  occurred,  rigor  mortis  will  have  set  in  and  per- 
haps signs  of  putrefaction  will  be  present  in  most  of  the  bodies 
and  furnish  infallible  tests.  In  case  of  doubt  and  an  early  decision 
is  necessary,  the  Icard  fluorescin  test  may  be  applied.  It  consists 
in  injecting  into  the  veins  or  the  muscular  masses  an  aqueous  solu- 
tion of  fluorescin,  so  as  to  show  the  persistence  or  the  cessation  of 
the  circulation  of  the  blood.  "  When  an  hour,  or  at  most,  two 
hours,  after  the  injection,  no  characteristic  coloration  from  the 
absorption  of  fluorescin  is  observed,  such  as  intense  yellowness  of 
the  skin  and  the  mucosa,  or  green  coloring  of  the  eyes,  it  may  be 
affirmed  without  doubt  that  death  has  taken  place." 

For  the  normal  and  prompt  disintegration  of  buried  bodies,  the 
soil  should  be  dry,  porous  and  naturally  well  drained,  in  order  to 
permit  a  free  circulation  of  air  and  promote  the  necessary  biological 
processes.  The  incipient  putrefaction  of  the  body  attracts  all  kinds 
of  necrophagous  insects  which  lay  their  eggs  on  or  in  the  soil ;  the 
larvae  penetrate  downward  to  the  body  and  therein  undergo  their 
various  metamorphoses.  Meanwhile,  the  saprophytic  bacteria  in 
the  body  multiply  enormously.  With  free  soil  ventilation,  insects 
and  bacteria  will  rapidly  bring  about  the  oxidation  and  destruction 
of  all  the  soft  tissues.  On  the  contrary,  if  the  soil  be  clayey  and 
damp,  or  marshy,  their  action  is  slow  or  arrested,  and  the  tissues 
undergo  transformation  into  adipocere,  or  corpse  fat,  which  may 
remain  unchanged  an  indefinite  number  of  years. 

When,  for  special  reasons,  it  is  desired  to  prevent  the  rapid  de- 
composition of  a  buried  body,  it  should  be  placed,  completely 
clothed,  in  an  air-tight  box,  and  the  latter  covered  with  a  layer  of 
lime  or  other  disinfectant.  On  the  battlefield,  however,  the  deside- 
ratum is  to  promote  rapid  oxidation  and  disintegration  of  the  tissues 
with  as  little  putrefaction  as  possible.  Therefore  the  bodies  should 
be  stripped  of  clothing  (at  least  of  outer  clothing),  free  aeration 
provided  and  disinfectants  avoided. 


HYGIENE   OF   THE   BATTLEFIELD.  751 

A  good  method  is  to  dig  a  pit  with  sloping  sides,  35  feet  long,  7 
wide  at  bottom,  and  6  or  7  deep  according  to  the  nature  of  the  sub- 
soil. All  around  the  bottom  is  a  small  trench  draining  into  a  well 
at  the  lower  end,  trench  and  well  being  filled  with  stones  or  brush. 
The  bodies  are  laid  across  in  3  or  4  superposed  rows,  the  rows 
separated  by  brush,  straw  or  other  available  vegetable  material. 
The  clothes,  if  not  otherwise  needed,  can  be  laid  on  the  top  row  to 
secure  additional  aeration.  The  pit  is  then  filled  up  with  earth 
which  is  piled  up  above  ground  into  a  convex  or  ridged  top  capable 
of  shedding  rain.  The  greater  the  number  of  bodies  buried 
together,  the  greater  and  more  active  will  be  the  biological  pro* 
cesses,  and  the  more  rapid  and  complete  the  disintegration  of  the 
bodies.  Lime  should  not  be  used  except  in  the  trench  and  well  at 
the  bottom  of  the  pit,  and  other  places  where  it  is  desired  to  prevent 
odors.  It  would  be  well,  if  time  permits,  to  dig  a  flue  leading  from 
the  upper  part  of  the  end  of  the  pit  to  a  shallow  hole,  a  few  feet 
away,  in  which  a  fire  is  made ;  this  fire  aspirates  and  burns  the  gases 
from  the  pit. 

In  selecting  sites  for  pits,  care  should  be  taken  that  they  do  not 
drain  into  a  nearby  water-course  likely  to  be  used  as  water-supply. 

Concerning  cremation,  it  must  be  remembered  that  human  bodies, 
and  all  animal  bodies,  are  not  easily  reduced  to  ashes.  They  re- 
quire a  hot  fire  kept  up  by  a  very  active  combustion.  In  most 
situations  an  improvised  furnace  of  brick  or  stone,  with  good  draft 
to  windward,  will  answer  the  purpose  provided  the  fuel  is  abundant. 
If  at  hand,  kerosene  or  tar  should  be  freely  poured  over  the  bodies 
and  fuel. 

The  carcasses  of  horses  and  other  dead  animals  must  also  be  dis- 
posed of  on  the  battlefield.  They  may  be  buried  or  cremated  as 
seems  best.  If  buried  the  general  principles  enunciated  above 
should  be.  observed.  If  cremated,  a  good  plan  is  to  eviscerate  them 
and  throw  some  of  the  fuel  inside  the  body. 


CHAPTER  LXI. 

NAVAL  AND  MARINE  HYGIENE. 

The  application  of  the  principles  of  hygiene  to  ships  is,  in  many 
respects,  very  different  from  their  application  to  troops  on  land  and 
requires  special  consideration.  The  whole  subject  has  been  care- 
fully investigated  by  the  Medical  Corps  of  the  Navy  and  described 
in  special  text  books.  In  this  Manual  it  is  only  intended  to  advert 
to  its  most  important  features. 

A  war  ship  is  comparable  to  a  small  active  manufacturing  town, 
with  a  crowded  population  of  carpenters,  blacksmiths,  electricians, 
firemen,  coal-heavers,  machinists,  gunners,  etc.,  surrounded  by  com- 
plex mechanical  devices  and  exposed  to  many  dangers  which  menace 
life  and  limb. 

A  ship  at  sea  is  entirely  thrown  upon  its  own  resources  and  must 
make  the  most  of  the  special  and  inevitable  conditions  in  which  it 
is  placed.  These  conditions  are  favorable  and  unfavorable.  Sea 
air  is  free  from  micro-organisms  and  all  obnoxious  organic  matter ; 
it  is  healthy,  invigorating  and  not  liable  to  sudden  or  great  changes 
of  temperature ;  advantages  from  which  the  seaman  benefits.  The 
vital  question  of  the  disposal  of  excreta  and  wastes  presents  no  diffi- 
culty since  everything  is  thrown  into  the  sea.  The  water,  usually 
distilled,  is  therefore  of  unquestioned  purity,  while  the  quantity  and 
quality  of  the  food  are  also  more  under  control  and  easily  main- 
tained to  the  proper  standard  than  among  troops  on  land.  The 
men,  while  afloat,  are  constantly  under  military  discipline  and  pre- 
cluded from  indulging  in  dangerous  dissipation.  Finally,  it  is 
easier  on  a  ship  to  direct  and  supervise  the  application  of  all  sani- 
tary measures,  as  well  as  to  detect  and  isolate  the  first  cases  of 
infectious  diseases  than  in  a  camp  or  garrison. 

The  great  and  irremediable  drawback  of  life  aboard  is  restricted 
space,  causing  inevitable  crowding,  close  intercourse  <and  personal 
contact,  together  with  more  or  less  community  of  effects  -and  cloth- 
ing, all  conditions  most  favorable  to  the  transmission  of  communi- 
cable diseases.  Ventilation  of  various  degrees  of  excellence  can 
be  secured  above,  but  is  often  very  unsatisfactory  below  decks, 

752 


NAVAL   AND    MARINE    HYGIENE.  753 

especially  in  the  depths  where  engineers,  mechanics,  firemen  and 
stokers  perform  their  habitual  duties.  Physical  exercise,  so  neces- 
sary to  all  young  men  (especially  walking  and  running,  that  easiest 
and  best  form  of  exercise),  is  quite  restricted,  often  impossible,  or 
else  becomes  an  irksome  task. 

It  is  somewhat  difficult  to  balance  these  advantages  and  disad- 
vantages of  life  afloat  and  draw  conclusions  as  to  its  effect  upon 
human  health.  According  to  the  mortuary  records  in  the  reports 
of  the  Surgeon  General  of  the  Navy  for  the  years  1906  and  1907. 
only  73  men  died  of  disease  on  board  vessels  out  of  a  total  disease 
mortality  of  318.  Of  the  four  diseases  which  caused  the  highest 
mortality  in  the  Navy,  viz.,  tuberculosis,  pneumonia,  typhoid  fever, 
cerebrospinal  meningitis,  there  were  n  deaths  afloat  and  91  ashore. 
For  1911,  the  ratio  per  thousand  of  daily  sick  (disease  and  injury) 
in  the  force  afloat,  ranged  from  8.62  to  10.46,  while  that  for  yards 
and  land  stations  was  12.27.  Although  the  force  afloat,  during  that 
year,  was  more  than  six  times  the  strength  of  that  in  yards  and 
stations,  its  mortality  from  disease  was  only  one-fourth  more, 
namely  25  and  20  deaths  respectively.  From  these  and  other  data 
it  has  been  pretty  conclusively  shown  that,  while  cruising,  seamen 
have  better  chances  of  health  (accidents  disregarded)  than  while 
on  shore  duty,  or  than  soldiers  in  garrison. 

A  comparison  between  the  statistics  of  the  Army  and  Navy  for 
the  year  1907  (an  average  normal  year)  is  interesting.  The  ratio 
of  deaths  in  the  Army  was  5.81  per  thousand  of  strength,  namely, 
3.44  from  disease  and  2.37  from  other  causes ;  in  the  Navy,  5.67, 
namely,  3.49  from  disease  and  2.18  from  other  causes.  The  five 
diseases  with  the  highest  ratio  of  deaths  are  the  same  in  both  ser- 
vices, in  the  following  order  of  mortality:  For  the  Army,  tuber- 
culosis, pneumonia,  cerebrospinal  meningitis,  typhoid  fever  and 
heart  disease ;  for  the  Navy,  pneumonia,  typhoid  fever,  cerebro- 
spinal meningitis,  tuberculosis  and  heart  disease.  While  the  rate 
of  discharges  in  the  Army  was  20.15  per  thousand,  it  was  28.57  in 
the  Navy,  a  notable  difference,  probably  exerting  a  -marked  influence 
in  lessening  the  mortality  of  the  Navy.  The  most  remarkable  dis- 
crepancy, however,  between  the  two  services  is  in  the  ratio  of  ad- 
missions and  readmissions  (to  hospital  or  treatment  involving  ex- 
emption from  duty),  being  1,218  per  thousand  in  the  Army  and 
only  740  in  the  Navy,  with  a  ratio  of  constantly  non-effective  of  46 


754  MILITARY    HYGIENE. 

in  the  Army  and  only  31  in  the  Navy.  Evidently  this  discrepancy 
is  to  be  explained  chiefly  by  the  different  methods  of  accounting 
for  the  sick  and  wounded  in  the  two  services,  especially  in  recording 
minor  ailments ;  but,  after  making  this  allowance,  it  seems  quite 
probable  that  the  morbidity  in  the  Navy  is  somewhat  less  than  in 
the  Army,  and  that  this  better  showing  is  mainly  due  to  the  excellent 
health  prevailing  among  the  men  afloat. 

In  the  British  Navy,  the  death  rate  for  1905  was  3.9,  namely  2.74 
for  disease  and  1.15  for  injuries,  with  admission  rate  of  735  and 
discharge  rate  of  23,  89. 

For  the  year  1911,  the  rate  of  deaths  from  disease  in  the  United 
States  Navy  and  Marine  Corps  was  2.11,  as  against  2.66  in  the 
Army.  This  slight  difference,  however,  appears  to  be  more  than 
offset  by  the  much  higher  rate  of  discharges  in  the  Navy  (18.75) 
than  in  the  Army  (12.28),  especially  for  tuberculosis  (4.30  and  2.85 
respectively),  the  disease  causing  the  greatest  number  of  discharges. 

The  mean  death  rate  for  the  two  years  1914  and  1915,  from 
disease  and  injuries,  was  4.42  in  the  Army  and  4.33  in  the  Navy. 

For  the  year  1911,  the  five  most  prevalent  diseases  in  the  Navy 
and  Marine  Corps,  in  order  of  admissions,  were :  venereal  diseases, 
tonsillitis,  skin  diseases,  influenza  and  bronchial  affections ;  while 
the  five  which  caused  the  greatest  number  of  deaths,  in  order  of 
mortality,  were:  tuberculosis,  pneumonia,  heart  disease,  typhoid 
fever  and  nephritis.  During  that  year  the  diseases  which  gave  the 
highest  rate  of  death  in  the  Army  were  tuberculosis,  measles,  pneu- 
monia, heart  disease  and  typhoid  fever.  It  is  seen  that,  with  oc- 
casional exceptions,  the  above  diseases  are  practically  the  same  in 
both  services. 

In  the  Navy  we  may  expect  higher  rates  of  those  infectious  dis- 
eases specially  favored  by  crowding,  such  as  influenza,  measles  and 
mumps.  The  confinement  of  many  men,  particularly  among  the 
engine  and  fire-room  forces,  below  decks,  where  they  are  deprived 
of  sunshine  and  a  free  circulation  of  air,  and  the  violent  changes  of 
temperature  to  which  they  are  subjected,  cause  a  higher  rate  of 
admission  for  tuberculosis  in  the  Navy.  Thus,  in  1910,  it  was 
shown  that  with  an  average  admission  rate  for  tuberculosis  of  5.9 
per  1,000  for  the  entire  Navy,  it  rose  to  8  for  engineers,  7.3  for 
electricians,  8.7  for  messmen  and  13.4  for  the  hospital  corps. 

From  the  discharge  tables  it  appears  that  during  the  years  1910 


NAVAL    AND    MARINE    HYGIENE.  755 

and  1911  the  proportion  of  mental  diseases  was  likewise  greater  in 
the  Navy.  For  this  there  is  no  satisfactory  explanation. 

One  class  of  ear  injuries  much  more  frequent  in  the  Navy  than  in 
the  Army  is  that  caused  by  the  firing  of  heavy  guns.  To  prevent 
this  the  usual  practice,  until  lately,  was  for  each  man  to  place  a 
pledget  of  cotton  in  each  ear,  loosely  packed,  and  keep  his  mouth 
slightly  opened  so  as  to  maintain  full  air  pressure  in  the  Eustachian 
tube.  Many  appliances  have  been  tried,  but  none  found  entirely 
successful.  The  "  Frank  ear  stopple  "  of  soft  rubber,  and  the  "  El- 
liot ear  protector  "  have  thus  far  proved  the  most  satisfactory.  The 
latter  consists  essentially  of  a  perforated  celluloid  ball,  of  the 
proper  size  to  fit  the  auditory  canal,  with  wing  to  hold  it  in  position. 
Another  preparation,  a  mixture  of  molder's  cla"  and  wool,  has  also 
been  well  spoken  of  in  the  British  Navy. 

RECRUITING.  —  Recruiting  in  the  Navy  is  governed  by  practically 
the  same  regulations  as  in  the  Army.  To  enlist,  applicants,  as  a 
general  rule,  must  be  21  and  not  over  35  years  old,  but  these  limits 
admit  of  exceptions;  thus  an  ordinary  seaman  may  enlist  when  18 
and  not  over  30  years  old;  an  apprentice  seaman  when  17  and  not 
over  25.  May  also  enlist  at  18,  landsmen  (not  for  seaman  branch), 
hospital  apprentices,  mess  attendants  and  ship's  cooks. 

The  standard  of  vision  is  higher  than  in  the  Army,  although  the 
necessity  for  this  is  not  apparent.  A  minimum  visual  acuteness  of 
20/30  is  required  in  each  eye  for  all  applicants,  but  no  man  can  be 
a  gun  pointer  who  has  not  a  vision  of  20/15  in  the  right,  or  aiming* 
eye  (that  is  to  say,  who  cannot  read  at  20  feet  the  line  on  the  test 
card  normally  read  at  15  feet),  and  a  vision  of  20/20  in  the  other 
eye.  The  reason  given  for  this  high  requirement  in  gun  pointers 
is  in  order  to  eliminate  certain  ocular  defects,  such  as  minor  degrees 
of  astigmatism. 

Owing  to  the  great  strain  to  which  the  sense  of  hearing  is  sub- 
jected by  the  firing  of  guns  aboard,  great  care  is  taken  in  the  ex- 
amination of  the  ears  to  ascertain  that  the  drums  are  sound  and  the 
Eustachian  tubes  patent. 

Training  Station.  —  On  account  of  the  crowding  more  or  less  un- 
avoidable on  a  ship  of  war,  it  is  most  important  that  every  possible 
measure  be  taken  to  prevent  outbreaks  of  infectious  disease  aboard. 
The  first  and  most  effective  measure  to  that  end  is  to  draw  the 
recruits  from  a  clean  source  of  supply,  that  is  to  say,  from  "  train- 


MILITARY    HYGIENE. 

ing  stations  "  and  "  receiving  ships  "  carefully  protected  from  pa- 
thogenic organisms.  The  receiving  ship  is  an  anachronism  and 
should  be  discontinued.  The  training  station,  to  fulfill  its  func- 
tions successfully,  should  consist  of  several  separate  departments 
through  which  the  recruits  are  successively  advanced :  one  for  their 
reception  and  examination,  another  for  their  detention  and  further 
observation,  and  a  third  for  those  finally  accepted  and  considered  fit 
to  go  aboard.  No  man  should  be  sent  aboard,  under  normal  condi- 
tions, who  has  not  been  in  detention,  under  observation,  for  at  least 
15  days.  In  these  departments  it  is  desirable  that  the  men  be  quar- 
tered- in  small  isolated  squad-rooms,  in  order  the  more  easily  to 
check  the  spread  of  any  infection.  Each  recruit  received  on  board 
must  be  carefully  inspected.  His  medical  history,  so  far  as  known, 
should  always  accompany  him.  Men  who  have  been,  or  are  sus- 
pected to  have  been,  exposed  to  infection  are  mustered  and  ex- 
amined, morning  and  evening,  during  the  full  incubation  period 
of  the  disease. 

VENTILATION. 

On  board  ship  the  air  space  is  a  variable  quantity  and  difficult  to 
determine,  depending  upon  the  size  of  available  compartments,  the 
amount  of  stores,  furniture  and  baggage  they  may  contain,  and  the 
number  of  men  to  be  berthed  in  each.  This  space  is  necessarily 
restricted,  sometimes  to  an  almost  inconceivable  degree,  but  it 
should  never  fall  below  140  cubic  feet,  which  is  hardly  any  more  than 
the  area  of  the  hammock  multiplied  by  the  height  of  the  deck. 
English  law  requires  that  in  forecastles  each  bunk  should  have  at 
least  72  cubic  feet  entirely  free  from  stores;  but  according  to  the 
best  authorities  this  minimum  should  never  be  less  than  100  feet. 
The  sick  bay  on  our  modern  ships  is  given  all  the  space  that  is 
deemed  practicable;  thus,  on  the  U.  S.  S.  Maryland,  it  is  10  feet 
high,  contains  35  folding  metal  beds  in  pairs,  and  each  bed  has  an  air 
space  of  260  feet.  The  effect  of  such  close  confinement  is,  of  course, 
mitigated  by  the  free  aeration,  natural  and  artificial,  of  the  compart- 
ments, and  By  the  fact  that  watches  are  changed  every  four  hours 
so  that,  except  on  troop-ships,  few  men  sleep  continuously  the  entire 
night  in  foul  air. 

The  construction  and  equipment  of  troop-ships  (transports)  is 
of  the  highest  importance  for  this  country  and  has  already  received 


NAVAL    AXD    MARINE    HYGIENE.  757 

careful  attention  from  the  War  Department,  on  account  of  the  fre- 
quent changes  of  the  regiments  stationed  in  our  distant  colonies. 

They  should  never  have  more  than  two  decks,  preferably  only  one, 
occupied  by  the  berths  of  soldiers.  Twenty  square  feet  of  floor 
space  should  be  allowed  as  a  minimum,  and  not  more  than  two  tiers 
of  hammocks  or  bunks  permitted.  "  Where  bunks  are  used,  the 
lower  tier  should  be  raised  not  less  than  18  inches  above  the  deck; 
with  not  less  than  three  feet  between  the  two  tiers,  and  between  the 
upper  tier  and  the  ceiling,  so  as  to  enable  the  occupants  to  sit  up- 
right. All  bunks  should  be  arranged  so  as  to  leave  a  passage-way 
at  least  30  inches  wide  between  each  other  and  the  side  of  the  ship, 
to  facilitate  cleansing,  allow  ready  communication  and  ventilation  " 
(Mitnson).  In  dimensions,  the  bunks  should  be  no  less  than  6  feet 
3  inches  by  2  feet.  A  high  standard  of  cleanliness  on  board  troop- 
ships is  of  the  utmost  importance.  As  a  large  proportion  of  the 
men  will  be  the  victims  of  sea-sickness  for  a  few  days,  special  ar- 
rangements must  be  made  to  catch  vomited  matters,  for  their  prompt 
removal  and  the  cleansing  of  soiled  floors  and  furniture. 

The  ventilation  of  a  ship  is  always  a  complicated  problem,  seldom 
successfully  solved  for  various  obvious  reasons :  the  immersion  of 
the  larger  part  of  its  body  which  precludes  openings,  while  many 
of  those  above  the  water-line  have  often  to  be  kept  closed;  the 
special  causes  of  pollution  to  which  its  atmosphere  is  exposed ;  its 
structural  irregularity,  involving  many  compartments  of  different 
shapes  and  sizes  and  used  for  a  variety  of  purposes. 

The  air  of  a  ship  is  contaminated  by  the  breathing  of  its  inmates, 
the  combustion  of  fuel  and  illuminants,  and  by  soiled  clothing  and 
bedding  like  that  of  barracks,  but  to  a  much  higher  degree  on  account 
of  the  greater  crowding.  There  are,  besides,  other  contributory 
causes  of  pollution  more  or  less  special  to  ships:  the  profuse  per- 
spiration of  the  men  in  the  boiler-  and  engine-rooms,  and  other 
heated  compartments ;  the  charred  organic  dust  of  the  air ;  the  gases 
from  coal  bunkers,  products  of  heat  and  moisture ;  the  effluvia  from 
heated  oil  and  grease,  from  tar,  paint,  bilge  water,  vomited  matters, 
water-closets,  galleys,  mess-rooms,  and  from  the  components  of  the 
store-rooms  and  cargo. 

The  bilge  water  is  the  drainage  of  the  ship,  to  which,  in  wooden 
ships,  is  added  more  or  less  leakage  from  without ;  the  putrefaction 
of  the  organic  matters  it  contains,  together  with  the  sulphides  de- 
rived from  the  sulphates  of  the  sea-water,  give  it  a  most  repulsive 


758  MILITARY    HYGIENE. 

fetid  odor.  In  modern  iron  ships  it  collects  into  the  main  drain 
which  runs  nearly  the  whole  length  of  the  ship,  and  seldom  accumu- 
lates to  any  objectionable  extent,  the  drain  being  frequently  pumped 
out  and  flushed. 

Next  to  the  bilge,  the  fore-  and  after-peaks  are  the  most  insani- 
tary parts  of  vessels  and  likewise  require  special  attention. 

The  bedding  should  be  thoroughly  aired  once  a  week  when  the 
weather  permits,  the  blankets  and  mattress  covers  washed  twice  a 
year  and  the  hammocks  once  a  month. 

The  ventilation  of  ships,  like  that  of  buildings,  is  natural  and 
artificial.  Natural  ventilation  is  effected  through  hatchways,  sky- 
lights, stairways,  hollow  masts,  port-holes,  side-lights  and  other 
openings,  as  well  as  through  revolving  tubes  with  hood  or  cowl 
made  to  face  the  wind,  and  windsails  or  canvas  cylinders  used  in 
the  same  manner.  The  principal  outlets  for  foul  air  are  the  casings 
or  jackets  of  the  funnels,  in  which  the  heat  causes  a  strong  up-draft. 
In  living  spaces  the  air-ports  are  usually  provided  with  pivoted  side- 
lights by  means  of  which  the  air  can  be  scooped  in  or  directed  out- 
ward as  desired.  Inlets  may  become  outlets  with  change  of  wind 
or  temperature. 

On  troop-ships  effective  ventilation  demands  that  every  possible 
obstruction  to  the  circulation  and  diffusion  of  air  be  removed ;  hence 
large  chests  and  bulky  articles  should  not  be  allowed  in  quarters. 
Bulkheads  must  be  as  few  as  possible  and  always  partly  opened  or 
latticed.  An  ideal  berth-deck  on  such  ships  would  be  one  consisting 
of  a  single  open  compartment  running  the  whole  length  of  the  vessel. 
Passage-ways,  longitudinal  and  transverse,  should  be  as  straight  as 
possible  so  as  to  favor  the  free  movement  of  air. 

Natural  ventilation,  however,  although  very  valuable,  is  irregular, 
unreliable  and,  except  for  the  upper  decks,  often  insufficient. 

In  engine-rooms  the  air  should  be  changed  at  least  every  two  min- 
utes ;  in  dynamo-rooms,  every  minute ;  in  all  quarters  and  living 
space,  every  12  minutes;  in  water-closets,  wash-rooms,  store-rooms, 
magazines,  every  eight  minutes.  The  amount  of  air  needed  in  en- 
gine- and  boiler-rooms  varies  also  with  the  speed  of  the  ship  and  the 
draft  of  the  fires.  Only  artificial  or  mechanical  ventilation  can  al- 
ways meet  such  requirements.  Two  systems  are  used ;  namely,  pro- 
pulsion, whereby  the  fresh  air  is  driven  in  by  electric  fans  or  blow- 
ers, and  extraction  or  exhaustion  in  which  the  foul  air  is  drawn  out. 


NAVAL   AND    MARINE    HYGIENE. 


759 


Until  recently  the  exhaust  system  had  been  depended  upon  in  bat- 
tleships to  a  much  greater  extent  than  is  approved  by  good  hygiene ; 
although  generally  satisfactory  on  the  upper  decks,  it  is  quite  in- 


LOOI-.INS  AfT 


FIG.  245. — Cross  section  of  ship  showing  system  of  ventilation  in  our  Navy, 
by  propulsion  and  extraction. 

adequate  below  the  armored  deck,  especially  within  the  citadel,  for 
want  of  enough  chance  inlets  to  admit  fresh  air.  It  also  frequently 
draws  air  from  contiguous  compartments,  and  may  thus  cause  foul- 


760  MILITARY    HYGIENE. 

ing  of  living  quarters.  It  is  indicated  for  water-closets,  lavatories, 
pantries,  store-rooms  for  volatile  supplies,  galleys,  laundries  and 
isolation  rooms. 

As  a  general  rule,  however,  experience  has  shown  that  both  sys- 
tems are  necessary  for  complete  ventilation,  and  therefore  a  double 
set  of  ducts  or  trunks,  one  for  supply  and  tye  other  for  exhaust. 
Each  important  compartment  should  have  its  own  ventilating  system, 
for  the  movement  of  air  is  much  impeded  by  bends  in  the  distribut- 
ing ducts.  The  inlets  and  outlets  should  be  as  far  apart  as  possible 
so  that  the  fresh  air  may  diffuse  itself  and  fulfill  its  purpose  before 
escaping.  Thus  in  boiler-  and  engine-rooms  the  best  method  would 
seem  to  be  to. propel  the  air  in  through  or  near  the  floor  by  many 
jets,  and  aspirate  it  through  the  ceiling  by  a  number  of  outlets  lead- 
ing into  an  exhaust  trunk  opening  above  the  upper  deck. 

Air  ducts,  on  account  of  convenience  of  construction,  are  gen- 
erally rectangular,  although  the  circular  form  is  more  economical 
as  regards  friction.  Wherever  they  pass  through  watertight  bulk- 
heads they  are  provided  with  valves  which,  in  case  of  accident  and 
flooding,  close  automatically. 

In  living  spaces  the  fresh-air  inlets  should  be  so  placed  and 
trimmed  or  protected  by  baffles  that  the  streams  of  air  will  be  broken 
up  and  so  distributed  as  to  prevent  drafts.  In  cold  weather,  the 
introduction  of  cold  air  in  heated  (or  often  superheated)  rooms 
exposes  the  occupants  to  unpleasant  and  dangerous  chilling  drafts. 
It  is  desirable  therefore  that  the  incoming  fresh  air  should  be 
moderately  warmed  before  its  admission  and  diffusion.  This  can 
be  done  by  placing  the  steam  coils  used  to  heat  the  compartments  in 
small  chambers  through  which  the  air  is  made  to  pass.  This 
decided  improvement  in  ventilation  is  being  tested  in  our  Navy, 
and  it  is  hoped  that  it  will  be  found  of  general  applicability. 

Temperature  and  Humidity.  —  The  temperature  and  humidity  of 
ships  deserve  mention.  They  are  heated  within  by  boilers,  engines, 
steam  pipes,  chemical  changes  in  the  cargo,  galleys  and  ovens,  and 
without  by  the  sun.  It  is  generally  considered  desirable  to  scatter 
the  auxiliary  engines  (dynamos,  windlasses,  condensers,  motors, 
etc.)  in  various  parts  of  the  ship  so  that  in  case  of  damage  or  acci- 
dent some  may  be  left  in  a  serviceable  condition.  The  compart- 
ments in  which  they  are  placed,  as  well  as  contiguous  rooms,  are 
thus  made  hot  and  damp,  and  often  difficult  to  ventilate.  The  neces- 


NAVAL    AND    MARINE   HYGIENE.  761 

sity  of  such  dispersion  is  beginning  to  be  questioned  by  naval  en- 
gineers and,  should  they  conclude  to  concentrate  all  these  engines 
within  the  strongest  part  of  the  citadel,  where  ventilation  is  generally 
very  good,  the  comfort  and  hygiene  of  the  ship  will  be  much 
improved  thereby. 

Iron  heats  and  cools  rapidly;  metal  ships  are  exceedingly  warm 
in  summer  and  cold  in  winter.  These  extremes  can  be  much  di- 
minished by  inside  wood  sheathing,  but  this  is  liable  to  decay  and  to 
harbor  vermin ;  morover,  on  men  of  war,  such  combustible  material 
is  not  permissible  as  it  would  considerably  add  to  the  danger  of  con- 
flagration in  an  engagement.  Solar  heat  is  best  excluded  by  awn- 
ings and  curtains,  often  sprinkled  with  water,  and  by  white  paint  on 
the  outside.  The  awnings  are  much  more  effective  if  double,  par- 
ticularly if  the  inner  canvas  is  dark-colored.  While  at  anchor,  in 
the  tropics,  the  ship  should  have  a  line  made  fast  to  the  stern  so 
that  its  broadside  may  always  be  kept  to  the  wind,  and  free  ventila- 
tion by  perflation  secured.  Besides  thorough  ventilation,  no  better 
method  of  cooling  compartments  on  board  ship  has  as  yet  been 
devised  than  the  use  of  electric  fans  which  stir  the  air  and  increase 
the  cutaneous  evaporation. 

Dampness  is  quite  marked  in  many  parts  of  ships ;  it  is  the  result- 
ant of  several  causes :  the  high  degree  of  relative  humidity  of  the 
air,  the  water  used  for  mopping,  the  breaking  of  the  waves  upon 
the  decks,  the  leaks  from  steam  pipes,  the  respiration  of  men 
crowded  within  very  limited  spaces.  This  moisture  readily  con- 
denses upon  the  cool  iron,  especially  at  night,  producing  the  phe- 
nomenon of  "  sweating,"  or  formation  of  droplets  of  water  on  metal 
surfaces,  often  dripping  into  the  bunks  and  a  cause  of  much  an- 
noyance. During  the  summer,  only  good  ventilation  has  any  marked 
effect  upon  it,  while  in  winter  it  is  removed  by  the  steam  heating. 
Some  mitigation  of  this  evil  is  obtained  by  using  cork  paint  on  all 
sweating  surfaces,  that  is  to  say,  ordinary  paint  sprinkled  with 
granulated  cork  and  covered  with  a  smooth  layer  of  zinc  white. 
Asbestos  cloth  has  also  been  recommended. 

The  old  pernicious  method  of  washing  wooden  decks  by  first 
flooding  them  with  water  is  fortunately  gradually  disappearing. 
The  washing  of  decks  should  be  done  with  as  little  water  as  possible, 
wetting  only  small  portions  at  a  time  and  drying  thoroughly,  and 
preferably  on  sunny  days,  in  order  to  prevent  prolonged  dampness. 


762  MILITARY    HYGIENE. 

The  lower  decks,  especially,  should  be  mopped  only  when  necessary 
to  insure  cleanliness.  By  sprinkling  clean  sand  and  sawdust  over 
them,  wooden  decks  can  be  preserved  from  much  soiling.  Simple' 
mopping  or  scrubbing  in  places  where  required,  together  with  holy- 
stoning and  dry  rubbing,  will  generally  accomplish  all  that  is 
necessary. 

The  use  of  linoleum,  varnished  over  with  shellac,  as  a  deck  cover- 
ing and  dressing  now  general  in  the  Navy,  renders  the  decks  neat, 
clean  and  free  from  the  dampness  which  formerly  resulted  from 
their  frequent  washing.  This  covering  is  particularly  of  sanitary 
value  in  the  living  and  messing  spaces  below  the  main  deck.  But 
to  fulfill  its  purpose  and  really  improve  the  healthfulness  of  ships  it 
requires  constant  attention.  The  shellac  should  be  put  on  freely 
so  that  the  linoleum  does  not  become  exposed,  stained  and  cracked. 
The  linoleum,  when  worn  and  torn,  permits  an  unseen  accumulation 
of  filth  and  moisture  underneath  it,  admirably  suited  to  the  prolifera- 
tion of  disease  germs.  When  in  that  state  it  is  worse  than  useless 
and  had  far  better  be  removed. 

If  the  cooling  of  the  living  spaces  is  always  difficult  in  summer, 
their  heating  in  winter  is  easily  accomplished.  Steam  heating, 
through  coils,  is  the  method  generally  used.  Hot  water  heating 
would  give  a  more  moderate  and  equable  warmth,  but  is  of  more 
difficult  and  costly  application.  Heating  must  always  be  accom- 
panied by  suitable  and  adequate  ventilation,  preferably  with  air 
moderately  warmed  as  already  explained. 

Personal  Hygiene.  —  In  the  Navy,  where  men  must  inevitably  live 
in  close  contact,  personal  hygiene  is  even  more  essential  than  in  the 
Army.  Body  cleanliness  has  become  one  of  the  characteristics  of 
our  Navy  personnel  and  is  effectually  maintained  by  force  of  public 
opinion  aboard  and  the  instrumentality  of  disciplinary  measures. 
"  On  board  ship  the  recruit  who  shows  a  disposition  to  eschew  the 
bath  is  always  an  object  of  the  crew's  active  attention  and,  if  neces- 
sary, a  scrubbing  is  administered  to  initiate  the  change  of  habit  " 
(Rep.  Surg.  Gen.,  1908).  Cleanliness  of  linen  is  as  essential  as  that 
of  the  body,  for  not  only  is  soiled  linen  malodorous  but  even  more 
liable  to  disseminate  germs  and  parasites  than  the  skin  itself.  Since 
the  infection  complicating  gunshot  wounds  is  the  result  of  the  dirt 
on  skin  and  clothing,  rather  than  on  the  missile,  all  authorities 
recommend  that  prior  to  an  engagement,  soldiers  and  sailors  should 


NAVAL   AND    MARINE   HYGIENE.  763 

bathe  and  put  on  clean  underwear  and  outer  garments;  if  this  be 
advisable  on  land  it  is  still  more  so  aboard  where  the  danger  from 
shell  wounds  is  much  more  serious. 

Ample  bathing  facilities,  in  the  form  of  shower-baths,  are  required 
on  board  ships,  especially  for  the  engineer's  force  whose  perspiring 
bodies  are  often  begrimed  with  dirt  and  oil.  Salt-  and  soft-water 
baths  should  be  provided.  It  has  been  reported  that  the  use  of  soft- 
water  for  this  purpose  is  not  as  general  as  it  might  be  in  our  Navy. 
Complaints  have  also  been  made  that  sometimes  the  salt  water  is  so 
hot  when  it  reaches  the  showers  (having  circulated  through  the  dis- 
tillers) that  it  renders  them  almost  useless. 

Swimming  is  for  the  sailor  one  of  the  most  valuable  of  accom- 
plishments, therefore  one  which  he  should  be  obliged  to  acquire, 
since  it  may  be  the  means  of  saving  his  own  life  -or  that  of  his 
comrades.  Swimming,  besides  cleaning  the  body,  is  a  capital  ex- 
ercise and,  were  it  for  that  reason  alone,  should  be  encouraged 
whenever  practicable.  It  is  necessary,  however,  to  use  some  caution 
and  ascertain  that  the  water  is  reasonably  pure.  Most  of  the  har- 
bors frequented  by  our  ships  are  more  or  less  polluted  with  sewage 
from  cities;  in  such  places,  therefore,  the  men  should  only  be 
allowed  to  go  swimming  during  floodtide.  There  is  also  danger  of 
infection  when  swimming  on  sides  of  ships  near  where  the  flush 
from  the  heads  (water-closets)  is  ejected. 

The  floors  of  water-closets  should  be  of  cemented  concrete  or  til- 
ing and  made  thoroughly  impervious.  Unless  well  constructed  and 
kept  in  good  repair,  the  jarring  and  vibration  of  the  ship  are  quite 
likely  to  cause  cracks  and  fissures  in  them,  which  become  receptacles 
for  urine  and  washings  and  the  cause  of  offensive  smells.  The  use 
of  valves  and  vent  pipes  is  necessary  in  water-closets  to  prevent 
"  blowing  "  as  the  ship  rolls,  and  the  discharge  of  tainted  air  in  the 
compartments.  In  the  best  form  of  closet  the  outlet  of  the  pan  is 
closed  by  two  valves  so  arranged  that  only  one  opens  at  a  time.  In 
closets  placed  below  the  water  line  and  where,  therefore,  discharge 
by  gravity  is  impossible,  the  flushing  is  effected  by  a  hand  pump.^ 
The  flush  water  should  not  be  hot;  if  the  heated  water  from  the 
distillers  is  used,  it  may  constitute  a  nuisance  on  account  of  the  odor- 
laden  steam  arising  from  the  fixtures. 

Considering  the  very  offensive  and  repulsive  odors  emanating  from 
unclean  mouths  and  decayed  teeth,  especially  in  crowded  spaces,  oral 


764  MILITARY    HYGIENE. 

hygiene  must  receive  careful  attention.  The  use  of  the  toothbrush 
and  tooth  powder  should  be  encouraged,  if  not  insisted  upon. 
Toothpicks  should  likewise  be  provided  and  kept  in  canteens;  the 
common  practice  of  using  matches  for  toothpicks  has  been  found  to 
be  responsible  for  a  certain  number  of  cases  of  inflammation  and 
ulceration  of  the  gums  and  other  parts  of  the  mouth.  The  employ- 
ment of  dentists  in  the  Navy,  as  now  provided  by  law,  has  filled  an 
urgent  need. 

The  ship's  barber  may  be  a  potent  agent  in  the  transmission  of 
various  diseases  from  his  hands,  clothing,  instruments  and  excre- 
tions, and  must  therefore  be  subjected  to  strict  sanitary  regulations. 
Some  naval  surgeons  insist  that  every  man  on  board  should  be 
required  to  shave  himself  and  the  barber's  functions  limited  to  hair 
cutting,  but  this  is  probably  no  more  feasible  than  in  the  Army. 
Each  person  should  at  least  have  his  own  shaving  implements  and 
material,  except  soap  which  had  better  be  used  in  liquid  form  or  as 
paste  (in  tubes).  Instruments  used  on  different  persons  should  be 
disinfected  after  each  operation  by  immersion  in  alcohol  and  after- 
ward in  a  strong  solution  of  either  formalin  or  cresol ;  clean  towels 
must  be  supplied  each  customer.  (See  Personal  Hygiene.} 

Tattooing,  formerly  very  prevalent  in  the  Navy,  and  still  too  com- 
mon, is  a  serious  evil  to  be  entirely  suppressed,  one  which,  in  the 
opinion  of  the  Surgeon  General,  calls  for  prompt  and  vigorous  offi- 
cial action.  It  is  well  known  that  this  practice,  as  dangerous  as  it  is 
absurd,  is  a  vehicle  for  the  transmission  of  constitutional  and  cutic- 
ular  disease ;  cases  of  syphilis  and  tuberculosis,  even  of  death  from 
blood-poisoning,  having  been  caused  by  it. 

The  danger  of  the  communication  of  diseases  by  the  saliva,  from 
the  mouth-to-mouth  use  of  common  drinking  cups,  has  long  been 
realized  in  the  Navy,  and  made  the  scuttle-butt  cup  an  object  of 
suspicion  and  apprehension.  This  difficulty  has  been  removed  by 
the  introduction  of  the  bubble  fountain  system  (see  p.  251)  whereby 
a  man  may  drink  without  contact  of  the  lips  to  the  pipe,  the  flow 
Joeing  governed  by  a  spring  faucet,  and  the  overflow  passing  into  the 
expanded  end  of  the  surrounding  drain.  This  device  also  saves 
water  and  time.  On  ships  not  provided  with  it  the  cup  should  be 
kept  submerged  in  a  solution  of  formalin  (1/2500). 

On  board  ship,  where  the  danger  of  communicating  infections 
diseases  by  contact  is  so  great,  nothing  is  better  calculated  to  main- 


NAVAL   AND    MARINE    HYGIENE.  765 

tain  a  high  standard  of  health  and  cleanliness  than  individual  inspec- 
tion of  the  enlisted  personnel  at  regular  times,  by  a  medical  officer. 
For  instance,  once  a  month,  each  man,  stripped,  should  pass  before 
the  surgeon  and  his  genital  organs  and  skin  be  rapidly  examined. 
Thus  are  venereal  and  cutaneous  diseases  discovered  and  habits  as 
to  cleanliness  ascertained.  This  examination  will  prompt  the  men 
to  report  venereal  affections  soon  after  they  break  out,  which  is  in 
the  interest  of  good  hygiene,  and  induce  the  uncleanly  to  make  more 
frequent  use  of  the  bath. 

Food.  —  The  Navy  ration  has  been  described  in  another  chapter. 
It  is  in  every  way  satisfactory  as  to  quantity  and  quality,  the  com- 
manding officer  having  ample  authority  to  avail  himself  of  local 
markets  whenever  desirable.  In  long  cruises,  however,  fresh  sup- 
plies may  become  scant  and  the  diet  somewhat  monotonous,  with 
deficiency  of  vegetable  components  and  an  excess  of  preserved 
meats.  Most  war  ships  and  transports  are  provided  with  ice  ma- 
chines and  cold  storage  so  as  to  insure  fresh  meat  and  other  perish- 
able supplies  for  several  weeks.  The  chief  trouble  in  feeding  the 
enlisted  men  of  the  Navy,  as  of  the  Army,  is  to  secure  the  services 
of  competent  cooks  in  sufficient  number,  so  that  the  components 
of  the  ration  may  be  best  utilized  and  always  well  prepared  and 
served.  Medical  officers,  in  both  services,  cannot  devote  too  much 
time  and  attention  to  the  composition  and  preparation  of  the  diet, 
under  the  various  conditions  of  duty  and  climate.  A  consolidated 
mess  has  decided  advantages  over  divided  messes,  but  for  its  suc- 
cess, requires  a  competent  and  zealous  commissary  steward  and  the 
intelligent  supervision  of  officers. 

In  order  to  prevent  scurvy  and  other  detrimental  effects  of  a  pro- 
longed salt-meat  diet,  the  Revised  Statutes  require  that  all  vessels 
bound  across  the  Atlantic  and  Pacific,  or  around  Cape  Horn  or 
Cape  of  Good  Hope,  or  engaged  in  whaling  or  sealing,  shall  carry 
a  sufficient  supply  of  lemon-juice  or  lime-juice,  and  vinegar. 

Water-supply.  —  This  is  an  easy  question  on  board  war  ships, 
transports  and  steam  liners,  all  supplied  with  evaporators  and  dis- 
tillers, and  where  only  distilled  water  is  allowed  for  drinking  and 
culinary  purposes.  It  is  to  be  remembered,  however,  that  distilled 
water,  although  free  from  organisms  and  therefore  incapable  of 
transmitting  infectious  diseases,  may  have  an  unpleasant  and  re- 
pulsive odor  and  taste,  and  possibly  cause  intestinal  irritation,  when 
the  raw  water  is  pumped  from  shallow,  polluted  harbors. 


766  MILITARY    HYGIENE. 

In  ports  where  cholera,  typhoid  fever  or  dysentery  prevail,  or 
where  the  harbor  is  contaminated  with  much  sewage  or  animal 
refuse,  the  use  of  harbor  water  on  any  of  the  decks  should  not  be 
permitted. 

In  the  absence  of  a  distilling  apparatus,  no  water  should  be  taken 
on  board  without  previous  examination  and  approval  by  the  ship 
surgeon,  if  practicable.  The  storage  of  such  water  is  sometimes  a 
matter  of  difficulty.  Galvanized-iron  tanks  are  best  for  the  pur- 
pose; they  should  be  coated  with  cement  to  prevent  the  action  of 
the  water  upon  the  iron,  and  have  large  manholes  for  purposes  of 
inspection  and  cleansing.  When  an  emergency  requires  the  use 
of  hogsheads  or  casks,  their  interior  should  be  thoroughly  charred, 
so  that  the  water  may  not  become  tainted  by  the  decomposition  of 
the  substances  it  extracts  from  the  wood.  The  amount  needed  for 
drinking,  cooking,  ablutions  and  washing  of  clothing  should  be  cal- 
culated on  the  basis  of  four  gallons  per  capita. 

DISINFECTION  OF  SHIPS. 

As  soon  as  an  infected  vessel  is  brought  alongside  the  quarantine- 
station  pier,  the  sick  (provided  their  condition  admits  of  removal), 
together  with  their  effects,  are  taken  directly  to  the  lazaretto  with- 
out disinfection.  The  rooms  thus  vacated  are  immediately  disin- 
fected. Cabin  passengers  and,  afterwards,  steerage  passengers  and 
the  personnel  of  the  ship,  are  taken  off  by  sections  to  the  steam 
and  formaldehyde  disinfection  chambers  for  treatment  of  their 
clothing  and  baggage,  and  then  assigned  to  quarters  at  the  station. 
Each  set  of  rooms  thus  vacated  is  at  once  subjected  to  disinfection. 
Bedding  and  other  articles  needing  the  action  of  steam  are  also 
carried  out. 

The  principal  agents  used  in  the  disinfection  of  the  vessel  proper 
are  sulphur  dioxid,  cyanid  gas,  bichloride  of  mercury  and  formalde- 
hyde gas.  For  the  hold  of  vessels,  either  of  the  first  two  is  used, 
followed,  in  the  case  of  wooden  vessels,  by  washing  with  a  solution 
of  bichloride. 

Sulphur  dioxid  is  an  efficient  disinfectant  so  far  as  the  hold 
and  compartments  of  vessels  are  concerned.  It  is  also  invaluable 
for  its  power  of  destroying  rodents  and  insects.  It  is  generated  by 
burning  sulphur,  5  pounds  per  1,000  cubic  feet  of  air  space,  or 
liberated  from  10  pounds  of  liquid  sulphur  dioxid,  sufficient  moist- 


NAVAL   AND    MARINE    HYGIENE.  767 

ure  being  supplied  by  steam  or  water;  time  of  exposure  24  hours 
in  metal  ships  and  48-72  hours  in  wooden  ships.  Whan  the 
cargo  cannot  be  removed,  the  sulphur  should  be  generated  from 
a  special  furnace  to  minimize  the  danger  of  fire.  The  chief  objec- 
tion to  sulphur  is  the  long  exposure  required  on  account  of  its  lack 
of  diffusiveness.  ' 

Cyanid  gas  (hydrocyanic  acid)  exceeds  sulphur  dioxid  in  efficiency 
as  a  fumigant  because  more  toxic  and  more  diffusive.  With  it  the 
fumigation  of  loaded  ships  is  effected  in  one  hour,  without  injury 
to  the  most  delicate  fabrics,  nor  to  a  perishable  cargo  of  fruits  or 
vegetables,  tea,  coffee,  tobacco,  etc.  It  has  been  found  that  5  ounces 
of  potassium  cyanid  per  1,000  cubic  feet  are  sufficient  for  the 
destruction  of  rats  and  insects,  making  cyanid  gas  the  cheapest  of 
fumigants.* 

Compared  to  sulphur  dioxid,  cyanid  gas  has  only  one  disadvan- 
tage, its  greater  danger  to  human  life,  but  this  is  easily  guarded 
against  by  proper  care.  (See  Insecticides.) 

In  computing  the  capacity  of  the  hold  of  a  vessel  to  determine 
the  quantity  of  fumigant  required,  it  is  assumed  that  the  net  tonnage 
of  the  vessel  indicates  the  cubic  capacity  of  her  cargo-carrying 
space,  and  that  ten  net  tons  represent  1,000  cubic  feet  of  space. 

In  the  case  of  all  vessels  treated  for  yellow  fever  or  plague 
infection,  fumigation  must  precede  everything  else  in  order  to 
insure  the  destruction  of  mosquitoes,  rats  and  other  vermin.  In 
wooden  vessels  it  must  also  be  used  first,  for  water  would  seal 
many  of  the  cracks  and  prevent  effective  gas  penetration. 

Before  applying  the  bichloride  solution  there  should  be  a  thor- 
ough mechanical  cleansing  of  all  parts  requiring  it,  with  lye  and  a 
stiff  brush.  This  solution  (made  up  of  i  part  of  bichloride  and  2 
parts  of  hydrocloric  acid  or  sodium  chloride  in  1,000  parts  of 
water)  is  thrown  against  all  surfaces  with  hand  pumps. 

For  application  to  polished  woods,  bright  metals  and  other  sur- 
faces injured  by  the  bichloride,  a  5  per  cent,  solution  of  formalin  or 
carbolic  acid  should  be  preferred. 

The  living  apartments,  parlors,  dining-rooms,  cabins  and  fore- 
castles may  also  be  disinfected  with  sulphur  or  bichloride,  but  for- 
maldehyde gas  (as  generated  by  the  autoclave)  is  generally  prefer- 

*  Public  Health  Report.     Surgeon  R.'H.  Creel.     Dec.  3,  1915. 


768  MILITARY    HYGIENE. 

able.  When  sulphur  is  used  its  destructive  action  must  be  borne 
in  mind  and  all  metal  surfaces  and  gilt  decorations  protected  by  a 
coating  of  vaseline. 

Vessels  are  seldom  so  badly  infected  as  to  need  disinfection 
throughout ;  the  parts  which  require  it,  and  the  best  method  to  effect 
it  must  first  be  determined.  There  is  no  reason,  for  instance,  to 
disinfect  the  staterooms  of  the  first  cabin  passengers  because  there 
is  a  case  of  smallpox  in  the  steerage  or  in  the  quarters  of  the  crew ; 
nor  to  disinfect  the  hold  of  a  vessel  and  break  the  cargo  because  of 
a  case  of  smallpox,  cholera  or  typhus  fever  in  the  cabins  or  steer- 
age. Special  measures  are  called  for  with  each  disease :  thus,  with 
cholera,  typhoid  fever  and  dysentery  particular  attention  must  be 
paid  to  the  water,  clothing  and  bedding;  especial  efforts  should  be 
directed  against  mosquitoes  in  yellow  fever  and  malaria ;  against 
rats  and  vermin  in  plague ;  while  in  smallpox  and  other  exanthemat- 
ous  diseases,  the  usual  careful  disinfection  of  living  compartments 
is  required. 

As  a  rule,  the  cargo  and  stores  do  not  need  disinfection^  except- 
ing when  consisting  of  rags  or  other  absorbent  articles,  household 
goods  or  food  products  coming  from  infected  localities.  In  the  case 
of  plague  infection,  sulphur  or  cyanid  gas  fumigations  are  neces- 
sary before  and  while  unloading  the  cargo,  in  order  to  insure  the 
destruction  of  all  rats  (as  described  under  Quarantine}.  The  bal- 
last is  liable  to  infection  and  its  removal  may  be  required. 

THE    SICK   BAY. 

The  hospital  or  infirmary  of  the  ship  should  be  so  located  as  to 
have  as  much  light  and  air  as  possible,  with  a  minimum  of  noise 
and  motion.  On  war  vessels  it  is  generally  on  the  berth  deck,  abaft 
of  the  forward  turret.  It  should  be  borne  in  mind  that  the  further 
aft  it  is,  the  less  motion  and  noise  will  disturb  it.  and  the  less  the 
liability  to  flooding  in  case  of  storm :  the  facilities  for  isolation  will 
also  be  better  and  the  danger  of  disseminating  infection  less.  As 
a  rule,  the  sick  bay  in  our  Navy  combines  most  of  the  advantages 
which  it  is  practicable  to  secure  for  the  sick  and  wounded  afloat. 
It  is  thus  described  by  Surgeon  General  Rixey: 

'  Turning  to  the  most  modern  type  of  ship,  like  the  '  Louisiana ' 
or  '  Pennsylvania '  or  '  Connecticut,'  we  find  a  relatively  com- 
modious, admirably  equipped  emergency  hospital,  consisting  of 


NAVAL   AND    MARINE    HYGIENE.  769 

wards,  isolation  room,  dispensary,  bathroom,  closet,  and  operating 
room,  modern  in  all  its  appointments.  All  the  indispensable  requi- 
sites are  provided  and  placed  in  a  manner  that  is  irreproachable 
for  operation,  dressing,  and  all  medical  care.  In  addition  to  modern 
aseptic  furniture,  instruments  of  precision,  laboratory  facilities,  an 
elaborate  surgical  outfit  and  sterilizers,  not  to  mention  an  abundant 
store  of  dressings  and  other  material,  there  is  good  light  and  ventila- 
tion, hot  and  cold  water,  ice,  etc.,  and,  above  all,  attendance  by 
trained  nurses  qualified  to  undertake  all  the  duties  of  their  calling  " 
("Keen's  Surgery"). 

Unfortunately,  the  sick  bay  is  rarely,  if  ever,  protected  by  heavy 
armor,  so  that  in  war  time,  at  the  beginning  of  an  engagement,  it 
becomes  untenable  and  must  be  abandoned.  A  naval  battle  is  very 
different  from  a  land  fight,  often  more  severe  and  destructive.  Its 
issue  is  not  decided  by  rifle  fire,  as  upon  land,  but  by  heavy  ord- 
nance, so  that  wounds  are  mostly  of  a  much  more  serious  character. 
Combatants  and  non-combatants  are  equally  exposed  above  the 
water-line;  nor  is  there  entire  safety  below  it,  the  men  thus  located 
being  in  greater  danger  of  mines  and  torpedoes. 

Where  to  collect  the  wounded  during  an  engagement,  so  that 
they  may  be  relatively  safe  and  not  in  the  way  of  combatants  while 
receiving  appropriate  treatment,  is  an  important  problem  which,  in 
the  event  of  war,  would  have  to  be  solved  on  each  ship  in  accordance 
with  its  structural  type.  Such  a  place  must  be  sought  behind  the 
heavy  armored  belt,  preferably  below  the  water-line ;  the  spaces 
between  the  bunkers  can  be  utilized,  since  coal  affords  relative 
protection.  Accessibility  is  a  great  advantage,  but  does  not  matter 
so  much  as  safety. 

The  great  value  of  protected  dressing-stations  in  saving  lives 
without  interfering  with  the  fighting  efficiency  of  the  ship,  has  been 
recognized  in  our  Navy.  They  are  provided  for  in  our  new  battle- 
ships, one  forward  and  one  aft,  behind  heavy  armor  and  adjacent 
to  hatches  extending  vertically  through  the  decks  BO  that  the 
wounded  may  be  rapidly  passed  down  from  the  various  deck  levels. 
They  are  fitted  with  all  necessary  appliances  for  lighting,  ventilation, 
steam  connections  for  sterilizers,  hot  and  cold  water,  water-closets, 
lockers,  etc.  In  ordinary  peace  time  this  compartment  is  to  be 
utilized  for  stores  or  other  purposes. 


7/O  MILITARY    HYGIENE. 

HOSPITAL    SHIP. 

The  hospital  ship,  in  peace  as  in  war,  is  now  recognized  as  a 
necessary  component  of  a  fleet.  The  Navy  Regulations  characterize 
it  as  follows : 

"A  hospital  ship  being  assimilated  to  a  naval  hospital  on  shore, 
will  be  commanded  by  a  naval  medical  officer  not  below  the  grade 
of  a  surgeon,  detailed  by  the  Navy  Department.  Such  vessels  will 
be  manned  by  a  merchant  crew  and  officers  and,  in  addition,  a 
detail  from  the  Hospital  Corps  of  the  Navy  for  carrying  out  the 
service  to  which  the  vessel  is  specially  assigned." 

"All  hospital  ships  shall  be  distinguished  by  being  painted  white 
outside,  with  a  horizontal  band  of  green  about  a  meter  and  a  half 
in  breadth.  The  boats  shall  be  distinguished  by  similar  painting. 
In  accordance  with  the  terms  of  the  Geneva  Convention,  all  hospital 
ships  will  fly  the  Geneva  Cross  flag  at  the  main  in  lieu  of  the  narrow 
pennant  or  coach  whip." 

"  The  neutrality  of  the  hospital  ship  will  at  all  times  be  pre- 
served." 

During  an  engagement,  the  hospital  ship  will  seldom  be  able  to 
render  much  service.  Any  attempt  to  do  so  must  be  clearly  in  pur- 
suit of  its  humane  mission  and  always  at  its  own  risk  and  peril. 
It  may  help  the  wounded  and  crews  of  sinking  ships  after  they 
have  surrendered,  or  when  in  such  condition  as  to  have  ceased  to 
be  a  factor  in  the  fight.  Most  of  its  efficient  work,  however,  will 
be  performed  at  the  close  of  the  battle. 

Besides  the  hospital  ship,  the  needs  of  a  fleet  also  include  the 
service  of  several  fast  "  medical  transports "  ready,  during  and 
after  an  engagement,  to  carry  needed  personnel  and  material  to  any 
of  the  ships  and  transfer  the  wounded  to  the  hospital  ship. 

Hospital  ships  for  the  Army  or  Navy,  whether  constructed  for 
the  purpose  or  adapted  from  the  merchant  marine,  should  combine 
certain  essential  features,  described  as  follows : 

Hull :  Of  iron  or  steel. 

Size :  Not  less  than  4,000  tons. 

Compartments:  At  least  four  good  water-tight  compartments. 

Bilge  keels. 

Length :  Not  less  than  350  feet. 

Beam :  Not  less  than  40  feet,  with  broad  under-water  lines  to 
secure  steadiness,  even  at  the  expense  of  speed. 


NAVAL   AND    MARINE    HYGIENE.  771 

Steaming  radius :  5,000  miles. 

Free  board:  There  should  be  as  much  free  board  as  possible  con- 
sistent with  steadiness  and  safety. 

Decks :  At  least  four  good  unincumbered  decks. 

1.  Superstructure  deck. 

2.  Upper  deck. 

3.  Main  deck. 

4.  Lower  deck. 

5.  Hold. 

Disposition  of  Space. 

SUPERSTRUCTURE  DECK.  —  Navigating  officers  with  offices,  state- 
rooms, and  mess-rooms,  forward;  senior  medical  officer's  adjoining 
captain's. 

Aft:  Infectious  ward ;  removable,  mosquito-proof,  double  canvas 
top ;  closets  and  washrooms  with  separate  plumbing ;  utensil  closet, 
nurses'  room,  and  medical  attendants'  room. 

Extreme  aft:  Disinfector  for  infected  material. 

Boats :  At  least  two  steam  launches  specially  equipped  for  trans- 
port of  sick. 

Junior  medical  officers  have  staterooms  near  sick  officers'  quar- 
ters, and  medical  officers  mess  in  the  wardroom  of  sick  officers. 

UPPER  DECK,  Forward.  —  Ward  for  sick  officers :  At  least  two 
suites  of  communicating  rooms  for  officers  of  high  rank,  with  bath 
and  closet  in  one  room,  and  standing  bed,  .stationary  eating  table  and 
clothes  locker  in  the  other. 

Other  rooms:  At  least  10  single  rooms  for  officers  of  commis- 
sioned rank,  except  cadets.  There  should  also  be  a  mess-room  with 
mess  table,  sideboard,  library,  easy  chairs,  pantry,  and  dumb-waiter. 
At  the  after  end  there  should  be  common  closets,  baths,  and  wash- 
room. 

Aft:  Medical  ward,  with  standard  bunks  single  or  double  banked, 
according  to  plan,  with  eating  board,  spit  cups,  and  ditty-box  at- 
tached. Head  nurse's  room.  In  rear  of  ward:  Baths,  closets, 
washroom,  and  examining  room.  Starboard  side  engine-room 
uptakes:  Dispensary  with  Navy  standard  fittings  complete,  and 
adjoining  stateroom  for  pharmacist.  Port  side: 

1.  Lounging-  and  smoking-room  for  officers. 

2.  Commissary's  office. 

3.  Medical  records  and  business  office. 


772  MILITARY    HYGIENE. 

MAIN  DECK,  Forward.  —  Medical  convalescent  ward  arranged 
the  same  as  the  medical  ward. 

Aft:  Surgical  ward,  with  operating  room,  X-ray  and  electro- 
therapeutic  room,  and  small  dark  and  developing  room  on  starboard 
side  forward;  recovery  room  adjoining.  Aft,  on  port  side  of  ward, 
pus  operating  room  and  dressing  room,  baths,  closets,  and  wash- 
room; on  starboard  side,  head  nurse's  room,  clinical  bacteriological 
room  and  dentist's  office,  outfit  complete,  Navy  or  Army  standard, 
with  working  library.  Port  side  uptakes :  Mess-rooms  for  con- 
valescents, with  pantries  and  warming  room.  On  starboard  up- 
takes, galleys,  bakeshops,  etc.  Adjoining  convalescent  ward,  for- 
ward; *ward  for  non-commissioned  officers,  with  adjoining  mess- 
room  and  pantries ;  closets  and  baths  on  port  side  connecting  with 
same  for  convalescent  medical  ward.  Aft  of  galleys :  Mess-room 
for  nurses,  hospital  stewards,  etc.  Pharmacist  to  mess  with  war- 
rant officers. 

LOWER  DECK,  Forward  Extreme.  —  Petty  officers'  mess-room, 
quarters,  bath,  closets ;  corresponding  space  on  main  deck  above  for 
crew. 

Mid-deck  Space.  —  Steam  laundry,  port  side  forward.  Ice  ma- 
chines (two),  capacity  3-4  tons,  starboard  side.  Disinfector,  drying 
room,  freight  elevator,  cargo  ports,  cells  for  prisoners,  and  padded 
cells  for  insane.  Dynamo  room. 

1  Aft:  Crew  space,  with  mess  tables,  Navy  standard  lockers,  library, 
and  master-at-arms'  office  and  stateroom.  Further  aft,  nurses,  with 
mess  tables,  lockers,  Navy  standard  pattern,  books  of  instruction, 
lecture  room,  berths.  Closets  with  washrooms  extreme  aft. 

HOLD,  Forivard.  —  Storerooms  for  vegetables  and  meats,  pantries 
for  officers'  mess,  storeroom  for  perishable  goods,  and  dead-room, 
with  Navy  standard  outfit. 

Aft:  Engineer  stores,  paymaster  stores,  medical  stores  for  use  on 
board  ship  and  for  distribution. 

Extreme  Aft:  Two  Army  regimental  hospitals  each  for  1,000 
men,  with  wheeled  litters,  for  use  with  landing  parties. 

Means  of  transportation  for  sick  and  wounded: 

1.  Wheeled  carriage. 

2.  Stretchers,  Stokes'  and  Army. 

3.  Cargo  ports. 


NAVAL    AND    MARINE    HYGIENE.  773 

4.  Electric  "  Otis  "  light-running  elevator  at  site  of  after  cargo 
ports,  running  to  all  decks. 

5.  Davits  and  whip. 

6.  Steam  launches. 

7.  Ladders. 

The  entire  ship  should  be  screened. 

Medical  and  Hospital  Corps  Personnel  for  a  Ship  of  200  Beds.  — 
Medical :    One  medical  officer  in  command  of  ship ;  four  medical 
officers  to  attend  the  patients. 
Hospital  Corps: 

Noncommissioned  officers:  Five  (5). 
Privates:  Thirty-five  (35). 

NOTE. —  In  1916,  Congress  having,  for  the  first  time,  authorized  the  build- 
ing of  a  hospital  ship  for  the  U.  S.  Navy,  according  to  plans  carefully  pre- 
pared in  the  Surgeon  General's  Office,  it  is  believed  that,  when  completed,  it 
will  be  a  model  of  its  kind  and  the  best  representative  of  all  the  advanced 
features  and  latest  improvements  to  be  expected  in  an  up-to-date  hospital 
ship. 


CHAPTER    LXII. 
QUARANTINE.* 

By  quarantine  is  meant  the  employment  of  such  measures  as  arc 
deemed  necessary  to  avoid  the  introduction  or  transmission  of  dis- 
ease from  one  country  or  locality  to  another. 

The  word  itself  is  derived  from  the  Italian  quarantine,  meaning 
forty,  the  number  of  days  during  which  ships  were  formerly 
detained.  The  first  maritime  quarantine  was  instituted  in  1403  at 
Venice,  but  measures  to  prevent  the  spread  of  plague  had  been 
previously  enforced  by  several  Italian  states. 

All  infectious  diseases  may  be  subjected  to  quarantine.  For  many 
years  quarantinable  diseases  were  limited  to  cholera,  typhus,  small- 
pox, and  yellow  fever.  The  statutes  of  New  York  now  comprise  as 
such,  "  yellow  fever,  measles,  cholera,  typhus,  small-pox,  scarlatina, 
diphtheria,  relapsing  fever,  and  any  disease  of  a  contagious,  infec- 
tious, or  pestilential  character  which  shall  be  considered  by  the  health 
officer  dangerous  to  public  health." 

Under  present  United  States  regulations,  the  quarantinable  dis- 
eases are  cholera,  typhus  fever,  plague,  small-pox,  yellow  fever,  and 
leprosy. 

The  period  of  detention  imposed  on  ships  and  persons  in  quar- 
antine for  any  disease  should  not  exceed  the  usual  period  of  incu- 
bation of  said  disease. 

Quarantine  may  be  maritime  or  inland ;  inland  quarantine  may  be 
interstate,  state,  or  municipal. 

Inasmuch  as  maritime  quarantine,  in  any  harbor  of  the  United 
States,  is  intended  to  protect  not  only  the  State  in  which  said  harbor 
is  situated,  but  also  the  adjoining  States  and  indirectly  the  entire 
country,  and  also  for  reasons  of  convenience,  efficiency,  uniformity 
and  economy  of  administration,  it  is  obvious  that  it  should  be 
entirely  under  federal  control.  Accordingly,  the  great  majority  of 
the  maritime  States  have  surrendered  their  quarantine  functions  to 

*  Based  on  laws  and  regulations  of  the  United  States  as  executed  by  the 
Public  Health  Service. 

774 


QUARANTINE.  775 

the  U.  S.  Government.  At  the  present  time  (1917),  there  are  only 
two  ports  (Baltimore  and  New  York)  whose  quarantine  stations 
are  still  directed  by  State  authorities,  but  it  is  expected  that  they 
also  will  soon  come  under  national  control. 

All  maritime  and  interstate  quarantine  powers  of  the  United 
States  are  vested  in  the  Public  Health  Service,  which  is  a  branch  of 
the  Treasury  Department,  and  directed  by  a  Surgeon  General. 

Under  existing  law  the  Public  Health  Service  cooperates  with  and 
aids  State  and  municipal  boards  of  health  in  the  execution  and 
enforcement  of  the  rules  and  regulations  of  such  boards  to  prevent 
the  introduction  of  contagious  or  infectious  diseases  into  the  United 
States  from  foreign  countries  and  into  a  State  or  Territory  from 
another  State  or  Territory ;  and  for  such  ports  and  places  within  the 
United  States  as  have  no  quarantine  regulations  under  State  or 
municipal  authority,  or  adequate  regulations  to  prevent  the  introduc- 
tion of  such  diseases  into  the  United  States  or  into  a  State  or  Terri- 
tory from  another  State  or  Territory,  the  Secretary  of  the  Treasury 
shall,  if  he  deems  necessary,  make  such  rules  and  regulations  as  may 
be  required  to  that  end.  If  the  States  and  municipalities  fail  or 
refuse  to  execute  and  enforce  these  regulations  the  President  is 
authorized  to  execute  and  enforce  them  and  adopt  such  measures  as 
in  his  judgment  shall  be  necessary  for  the  purpose. 

The  federal  control  of  maritime  quarantine  does  not  affect  the 
right  of  the  seaboard  States  and  municipalities  to  maintain  their  own 
quarantine,  in  addition,  if  they  so  desire. 

Maritime  quarantine  is  directed  against  the  introduction  of  disease, 
chiefly  from  abroad,  through  the  medium  of  vessels,  their  crews, 
passengers  and  cargoes.  It  begins  at  the  port  of  departure.  The 
United  States  regulations  require  that  masters  of  vessels  departing 
from  any  foreign  port,  or  from  any  port  in  the  colonies  of  the  United 
States,  for  a  port  in  the  United  States  or  its  colonies,  must  obtain  a 
bill  of  health  signed  by  the  proper  consular  or  medical  officer  of  the 
United  States.  Should  such  vessels  call  at  intermediate  ports  they 
must  procure  at  said  ports  a  supplemental  bill  of  health. 

Are  usually  exempt  from  this  requirement  all  vessels  clearing  from 
adjacent  Canadian  and  Mexican  ports  unless  quarantinable  diseases 
prevail  thereat. 

Before  issuing  the  bill  of  health  the  consular  or  medical  officer  will 
satisfy  himself  that  the  vessels,  passengers,  crews  and  cargo  have 
complied  with  all  the  quarantine  regulations  of  the  United  States. 


7/6  MILITARY    HYGIENE. 

Quarantine  stations  must  have  adequate  provisions  for  the  board- 
ing and  inspection  of  vessels ;  appliances  for  their  mechanical  cleans- 
ing and  disinfection ;  a  hospital  for  the  treatment  of  contagious  dis^ 
eases,  and  another  for  the  treatment  of  non-contagious  diseases; 
barracks  for  the  detention,  in  groups,  of  persons  who  have  been 
exposed  to  contagion;  also  laboratory,  steam  laundry,  crematory, 
etc.  (see  Disinfection  of  Ships). 

Every  vessel  subject  to  quarantine  inspection,  entering  a  port  of 
the  United  States  or  its  colonies,  shall  fly  a  yellow  flag  at  the  fore- 
masthead  and  be  considered  in  quarantine  until  given  free  pratique. 

SPECIAL    UNITED    STATES    QUARANTINE    REGULATIONS. 

For  Cholera.  —  For  the  purpose  of  these  regulations,  five  days  are 
considered  as  the  period  of  incubation.* 

The  law  provides  that  officers  of  the  Public  Health  Service  shall 
be  stationed  in  cholera-infected  ports,  or  in  ports  where  emigrants 
from  infected  districts  embark  for  America.  They  enforce  the 
United  States  regulations  providing  for  five  days'  observation  in 
barracks  before  sailing,  elimination  of  foodstuffs  from  baggage  and 
disinfection  of  their  effects.  On  arrival  in  an  American  port,  the 
ship  is  again  subject  to  a  detention  of  five  days.  Inasmuch  as  the 
cholera  bacillus  may  exist  in  the  intestines  of  healthy  persons  and 
that  the  usual  quarantine  inspection  is  ineffective  against  such  "  car- 
riers," a  bacteriological  examination  of  the  stools  of  all  steerage 
passengers  coming  from  infected  ports  and  places  is  also  required 
before  release.  Such  examination  is  likewise  made  of  the  stools  of 
any  passenger  suffering  from  diarrhea. 

"If  cholera  has  appeared  on  board,  remove  all  passengers  from 
the  vessel  and  all  of  the  crew.,  save  those  necessary  to  care  for  her ; 
place  the  sick  in  hospital.  Carefully  isolate  those  -especially  sus- 
pected, and  segregate  the  remainder  in  small  groups.  No  communi- 
cation should  be  held  between  these  groups.  Those  believed  to  be 
especially  capable  of  conveying  infection  must  not  enter  the  place  of 
detention  until  they  are  bathed  and  furnished  with  non-infected 
clothing;  nor  shall  any  material  capable  of  conveying  infection  be 
taken  into  the  place  of  detention,  especially  food  and  water." 

*  International   Sanitary  Convention  of  Paris,   1903. 


QUARANTINE.  777 

The  water-supply  of  the  vessel,  if  suspected  of  infection,  must  be 
disinfected,  then  discharged  and  the  tanks  thoroughly  rinsed. 

Living  apartments  and  other  portions  of  the  vessel,  as  well  as  all 
baggage,  effects  and  articles  of  cargo,  which  have  been  exposed  to 
infection,  must  be  disinfected. 

Water  ballast  taken  on  at  a  cholera-infected  port  should  be  dis- 
charged at  sea  and  the  tanks  disinfected. 

For  Plague.  —  For  the  purpose  of  these  regulations,  five  days  shall 
be  considered  as  the  period  of  incubation.* 

At  ports  where  plague  prevails,  every  precaution  must  be  taken  to 
prevent  the  vessel  becoming  infected  through  the  agency  of  rats, 
mice,  flies,  fleas,  ants,  or  other  animals.  The  vessel  should  not  be 
at  the  dock,  or  anchor  near  any  place  where  such  animals  may  gain 
access  to  it.  Access  through  the  cables  is  prevented  by  tarring  them 
and  providing  them  with  inverted  cones.  Communication  between 
the  vessel  and  shore  must  be  reduced  to  the  minimum  absolutely 
necessary. 

Careful  observations  should  be  made  during  voyages  from  plague- 
infected  ports  to  ascertain  any  marked  sickness  or  increased  mortal- 
ity among  the  rats  on  shipboard.  Experience  has  shown  that  an 
outbreak  of  plague  in  man  is  almost  invariably  preceded  by  an 
increased  mortality  among  rats  and  mice. 

Suspected  vessels  coming  to  quarantine  shall  be  anchored  at  a 
sufficient  distance  from  the  shore  or  other  vessels  to  prevent  the 
escape  of  rats  by  swimming. 

If  any  cases  have  occurred  during  the  voyage,  passengers  and 
crew  should  be  examined  with  special  reference  to  the  glandular 
regions.  Doubtful  cases,  especially  of  the  pneumonic  type,  may  be 
subjected  to  bacteriological  examination  before  the  vessel  is  released. 

The  sick  are  sent  to  the  hospital.  The  crew  and  passengers  are 
removed  and  segregated  into  small  groups  and  held  under  close 
observation  for  five  days.  Any  person  who  has  been  directly 
exposed  should  be  bathed  and  his  belongings  fumigated. 

Nothing  shall  be  thrown  overboard  from  the  vessel,  not  even  deck 
sweepings.  Such  material  will  be  burned  in  the  furnaces  of  a 
steamer  or  in  a  place  specially  designated,  but  not  in  the  galley. 

As  soon  as  practicable  there  shall  be  a  thorough  and  simultaneous 
disinfection  of  all  parts  of  the  vessel  with  sulphur  dioxid  or  cyanid 

*  International  Sanitary  Convention  of  Paris,  1903. 


7/8  MILITARY    HYGIENE. 

gas  for  the  destruction  of  rats  and  vermin.  The  killing  of  escaping 
rats  should  be  provided  for  by  a  water  guard  in  small  boats.  No 
person  with  abrasions  or  open  sores  must  be  employed  in  the 
handling  of  the  vessel  or  her  cargo.  The  rats  will  be  subsequently 
gathered  and  burned,,  due  precautions  being  taken  not  to  touch  them 
with  bare  hands.  With  sulphur  dioxid  the  disinfection  is  fractional ; 
after  twelve  hours'  exposure,  overnight,  the  upper  layer  of  cargo  is 
removed  and  placed  on  lighters  exposed  to  the  sun ;  this  process  of 
disinfection  by  night  and  removal  of  successive  layers  of  cargo  by 
day  is  to  be  continued  until  the  hold  is  empty.  With  cyanid  gas, 
fractional  disinfection  is  seldom  necessary. 

For  Yellow  Fever.  —  For  the  purpose  of  these  regulations,  six  days 
are  considered  as  the  period  of  incubation.* 

While  in  an  infected  port,  the  vessel  must  lie  at  approved  moorings 
in  the  open  harbor  and  not  approach  the  wharves;  nor  must  the 
crew  be  allowed  ashore.  Every  possible  precaution  should  be  taken 
to  prevent  the  introduction  of  mosquitoes,  and  their  breeding  on 
board.  Before  the  stowing  of  cargo  or  receiving  of  passengers  the 
vessel  should  be  carefully  fumigated. 

Inasmuch  as  the  yellow-fever  mosquito  (Stegomyia)  occurs  natu- 
rally from  the  Gulf  of  Mexico  to  Virginia,  it  follows  that  measures 
of  quarantine  at  southern  ports  need  be  much  stricter  than  further 
north  where  the  Stegomyia  is  not  found,  except  when  imported  and 
then  only  for  a  short  time. 

If  the  vessel  has  properly  complied  with  the  quarantine  regula- 
tions to  be  observed  at  foreign  infected  ports,  and  arrives  at  a  north- 
ern port  (north  of  the  southern  boundary  of  Maryland)  without 
sickness,  after 'six  days  from  the  time  of  departure,  she  may  be 
admitted  to  pratique  immediately  after  fumigation,  without  deten- 
tion. If  she  arrives  in  less  than  six  days  she  may  be  admitted  to 
pratique  without  further  detention  than  is  necessary  to  complete  the 
six  days.  If  arriving  after  a  longer  voyage  than  twelve  days,  she 
may  be  subjected  to  the  full  period  of  detention,  on  the  ground  that 
a  case  of  yellow  fever  might  have  occurred  aboard  and  recovered, 
thus  making  her  infection  possible. 

Vessels  shall  be  held  in  quarantine  if  arriving  ai  a  port  south  of 
the  southern  boundary  of  Maryland  in  the  season  of  close  quaran- 
tine, May  i  to  November  i  (directly  or  via  a  northern  port),  from 

*  Second  Sanitary  Convention  of  American  Republics,  Washington,  1905. 


QUARANTINE.  779 

a  tropical  American  port,  unless  said  port  is  known  to  be  free  from 
yellow  fever. 

If  cases  of  yellow  fever  have  occurred  aboard,  remove  them  to 
the  hospital  by  screened  ambulance  or  litter,  and  place  them  in  a 
ward  thoroughly  protected  against  mosquitoes.  Remove  likewise 
and  isolate  all  persons  not  required  for  the  care  of  vessel ;  then 
destroy  the  mosquitoes  on  board  by  the  simultaneous  fumigation  of 
all  parts  of  the  vessel  by  sulphur  dioxid.  If  a  fresh  crew  is  avail- 
able the  vessel  may  now  be  released  without  further  detention, 
reshipping  the  old  crew  left  at  the  quarantine  station  on  her  next 
outward  voyage. 

Vessels  need  not  be  subject  to  quarantine  when  engaged  in  the 
fruit  trade,  provided  they  have  fully  complied  with  the  special  rules 
and  regulations  enacted  for  their  guidance  and  benefit. 

Passenger  traffic  without  detention  may  also  be  allowed  during  the 
close  quarantine  season  from  infected  ports  to  ports  in  the  United 
States,  even  south  of  the  southern  boundary  of  Maryland,  when  all 
passengers  and  crew  are  immune  to  yellow  fever,  the  vessel  is  of 
iron  and  in  first-class  sanitary  condition,  and  every  precaution  has 
been  taken  in  the  infected  port  to  prevent  the  ingress  of  mosquitoes. 

The  disinfection  of  baggage  for  yellow  fever  is  not  required  unless 
the  quarantine  officer  has  sufficient  grounds  to  believe  that  it  harbors 
mosquitoes. 

For  Small-pox.  —  For  the  purpose  of  these  regulations,  fourteen 
days  are  considered  as  the  period  of  incubation. 

On  all  vessels  arriving  with  small-pox  on  board,  or  having  had 
small-pox  during  the  voyage,  any  of  the  passengers  and  crew  who 
have  been  exposed  to  the  infection  must  be  vaccinated  or  detained 
in  quarantine  not  less  than  fourteen  days,  unless  they  show  satisfac- 
tory evidence  of  recent  successful  vaccination  or  of  having  had 
small-pox. 

Such  vessels  need  not  be  quarantined  further  than  the  removal  of 
the  sick,  the  disinfection  of  all  compartments,  baggage  and  objects 
that -have  been  exposed  to  infection,  and  such  vaccination  of  the 
personnel  as  required  in  the  previous  paragraph. 

For  Typhus  Fever.  —  For  the  purpose  of  these  regulations,  twelve 
days  are  considered  as  the  period  of  incubation. 

Vessels  in  otherwise  good  sanitary  condition,  but  having  typhus 
fever  on  board  which  has  been  properly  isolated,  need  not  be  quar- 


780  MILITARY    HYGIENE 

antined  further  than  the  removal  of  the  sick,  and  fumigation  of  the 
compartments  and  their  contents  likely  to  be  infested  with  vermin. 

If  the  cases  have  not  been  isolated,  or  the  disease  has  spread,  the 
vessel  will  be  quarantined,  the  sick  removed,  all  persons  who  have 
been  exposed  examined  and,  so  far  as  deemed  necessary,  their  per- 
sons, clothing  and  effects  treated  for  the  destruction  of  vermin. 
Passengers  upon  whom  lice  are  found  will  be  detained  to  the  end 
of  the  period  of  incubation,  i.  e.,  12  days. 

Living  compartments  and  all  other  parts  of  the  vessel,  as  well  as 
baggage  and  effects  likely  to  be  infested,  must  be  fumigated. 

For  Leprosy.  —  The  period  of  incubation  of  this  disease  is  still 
undetermined. 

Vessels  arriving  at  quarantine  with  leprosy  on  board  shall  not  be 
granted  pratique  until  the  leper,  with  his  baggage,  has  been  removed 
to  the  quarantine  station,  and  the  living  compartment  or  part  of  the 
vessel  which  has  been  exposed  to  infection  properly  disinfected. 

No  alien  leper  shall  be  landed.  He  will  be  detained  at  the  quar- 
antine station  until  again  put  aboard  the  vessel  that  brought  him, 
for  his  return  to  the  port  of  embarkation,  as  provided  by  law. 

INTERSTATE  QUARANTINE. 

For  the  purpose  of  these  regulations  the  quarantinable  diseases 
are  the  same  as  in  maritime  quarantine,  namely :  cholera,  plague, 
yellow  fever,  small-pox,  typhus  fever,  and  leprosy. 

The  general  principles  governing  interstate  quarantine  are  the 
same  as  those  pertaining  to  maritime  quarantine,  but  instead  of  deal- 
ing with  ships  as  media  of  transportation  we  must  deal  with  trains, 
steamboats,  and  wheeled  vehicles. 

The  law  requires  that  State  and  municipal  health  officers  shall  im- 
mediately notify  the  Public  Health  Service,  by  telegraph  or  letter, 
of  the  existence  of  any  of  the  quarantinable  diseases  in  their  respec- 
tive States  or  localities.  All  cases  of  quarantinable  diseases  or  sus- 
pected of  belonging  to  this  class  shall  be  at  once  reported  by  the 
physician  in  attendance  to  the  proper  authorities.  These  notifica- 
tions are  of  extreme  importance  and  must  be  strictly  enforced  so 
that  suitable  measures  may  be  taken  before  the  epidemic  acquires 
headway  and  begins  to  spread. 

Persons  suffering  from  a  quarantinable  disease,  or  suspected  to 
be  so,  shall  be  removed  to  a  hospital  or  otherwise  isolated  until  no 


QUARANTINE.  781 

longer  capable  of  transmitting  the  disease.  Those  who  have  been 
exposed  to  the  infection  shall  be  isolated,  under  observation,  for 
such  a  period  of  time  as  may  be  necessary  to  demonstrate  their  free- 
dom from  it. 

The  apartments  occupied  by  persons  suffering  from  quarantinable 
disease,  and  adjoining  apartments  when  deemed  infected,  together 
with  articles  therein,  shall  be  disinfected  upon  the  termination  of 
the  disease. 

No  common  carrier  shall  accept  for  transportation  any  person 
suffering  with  a  quarantinable  disease,  nor  any  infected  article  of 
clothing,  bedding  or  personal  property.  Bodies  of  persons  who 
have  died  from  any  such  disease  shall  not  be  transported  save  in 
hermetically-sealed  coffins,  and  by  the  order  of  the  State  or  local 
health  officer. 

In  the  case  of  yellow  fever,  a  place  shall  not  be  considered  entirely 
free  from  infection  until  after  the  expiration  of  eighteen  days 
(namely,  twelve  days  for  incubation  in  mosquito  and  six  days  for 
incubation  in  bitten  patient). 

In  addition  to  the  national  quarantine.  State  or  municipal  author- 
ities may  make  such  additional  regulations  as  they  deem  necessary 
for  the  preservation  of  the  health  of  the  people  within  their  juris- 
diction. 

Under  interstate  and  State  quarantine  are  included  sanitary 
cordon,  camp  of  detention,  railroad  quarantine,  disinfection  stations, 
and  inspection  service. 

The  sanitary  cordon  consists  of  a  line  of  guards,  military  or  civil, 
thrown  around  a  district  or  locality,  either  to  protect  the  same  from 
the  surrounding  country  when  infected,  or  to  protect  the  surround- 
ing country  from  an  infected  district  or  locality.  Sometimes  a 
double  cordon  is  necessary,  the  outer  one  embracing  the  whole  sus- 
pected territory,  the  inner  investing  more  closely  the  well-defined 
infected  locality.  Sanitary  cordons  have  been  mostly  used  in 
Europe  and  Asia  to  guard  against  the  spread  of  plague  and  cholera, 
and  in  this  country  against  the  spread  of  yellow  fever. 

A  camp  of  detention  is  a  place  to  which  persons  from  infected 
points  can  go  or  are  sent,  to  be  kept  under  observation  a  sufficient 
length  of  time  to  demonstrate  whether  they  are  or  are  not  infected ; 
if  infected  they  are  removed  to  a  special  hospital:  if  not,  they  are 
released  after  disinfection  of  their  clothing  and  baggage. 


782  MILITARY    HYGIENE. 

Camps  of  detention  should  be  established  with  due  regard  to  site, 
water  and  drainage,  and  subjected  to  strict  discipline.  Every  appli- 
cant must  be  examined  by  a  physician  before  admission  to.  ascertain 
the  state  of  his  health.  His  clothing  and  baggage  are  carefully  in- 
spected and,  if  need  be,  disinfected.  All  ingress  and  egress  are 
allowed  only  through  the  established  portal.  The  inmates  are  made 
as  comfortable  and  cheerful  as  possible,  all  proper  amusements  and 
entertainments  being  encouraged  and  promoted.  Each  person,  on 
leaving  camp,  is  given  a  certificate  that  he  has  passed  the  required 
period  of  detention. 

Such  places  should  not  be  confounded  with  camps  of  refuge  which 
are  simply  residence  camps  established  to  receive  the  non-immune 
population  of  an  infected  community  and  where  it  can  remain  in 
comparative  safety  until  the  epidemic  is  stamped  out. 

Railroad  and  steamboat  quarantine  consists  in  restricting  all  egress 
from  an  infected  State  or  locality  to  a  few  stations  on  railroad  and 
steamboat  lines,  and  maintaining  an  efficient  system  of  inspection  at 
those  stations.  Inspectors,  properly  uniformed,  board  all  outgoing 
trains  and  steamboats  and  demand  of  each  passenger  a  certificate 
from  a  health  officer  showing  where  he  has  been  during  the  previous 
five  or  six  days,  according  to  the  disease  to  be  guarded  against.  In 
case  of  doubt,  passengers  are  sent  to  camps  of  detention. 

Municipal  quarantine  includes  not  only,  the  measures  necessary  to 
prevent  the  introduction  of  disease  into  communities  or  its  transmis- 
sion from  a  city  to  neighboring  cities  and  States,  but  also  those  re- 
quired to  prevent  its  spread  within  cities.  It  applies  not  only  to  the 
quarantinable  diseases  already  described,  but  also  to  all  other  infec- 
tious diseases  such  as  scarlet  fever,  measles,  diphtheria  and  tuber- 
culosis. 

An  important  factor  in  municipal  quarantine  is  the  house-to-house 
inspection  to  ascertain  the  actual  number  of  existing  cases  of  disease. 
This  naturally  involves  domiciliary  quarantine  or  the  exercise  of 
restrictive  measures  against  a  particular  house  or  part  of  a  house; 
these  are  enforced  by  the  stationing  of  guards  to  see  that  none  but 
authorized  persons  enter  or  leave  the  infected  premises. 

It  is  very  important  that  as  many  of  the  sick  as  possible  should 
be  removed  to  special  hospitals,  thus  increasing  the  facilities  and 
efficiency  of  administration  and  diminishing  the  number  of  foci  of 
infection. 


QUARANTINE.  783 

THE  FOLLOWING  ARTICLES  OF  THE  SECOND  INTERNATIONAL 

SANITARY  CONVENTION  OF  THE  AMERICAN  REPUBLICS 

(WASHINGTON,  D.  C.,  1905),  BASED  ON  THE 

CONVENTION   OF  PARIS,    1903,    HAVE 

SPECIAL  INTEREST. 

ARTICLE  I.  —  Each  government  shall  immediately  notify  other 
governments  of  the  first  appearance  in  its  territory  of  authentic  cases 
of  plague,  cholera,  or  yellow  fever. 

ARTICLE  II.  —  This  notification  is  to  be  accompanied,  or  very 
promptly  followed,  by  the  following  additional  information : 

1.  The  neighborhood  where  the  disease  has  appeared. 

2.  The  date  of  its  appearance,  its  origin  and  its  form. 

3.  The  number  of  established  cases,  and  the  number  of  deaths. 

4.  For  plague,  the  existence  among  rats  or  mice  of  plague  or  of 
an  unusual  mortality ;  for  yellow  fever,  the  existence  of  Stegomyia 
fdsciata  in  the  locality. 

***** 

ARTICLE  IV.  —  The  notification  and  the  information  prescribed  in 
Articles  I  and  II  are  to  be  followed  by  further  communications  dis- 
patched in  a  regular  manner  in  order  to  keep  the  governments  in- 
formed of  the  progress  of  the  epidemic. 

These  communications  which  are  to  be  made  at  least  once  a  week, 
and  which  are  to  be  as  complete  as  possible,  should  indicate  in  detail 
the  precautions  taken  to  prevent  the  extension  of  the  disease. 

They  should  set  forth :  first,  the  prophylactic  measures  taken  rela- 
tive to  sanitary  or  medical  inspection,  to  isolation  and  disinfection ; 
second,  the  measures  taken  relative  to  departing  vessels  to  prevent 
the  exportation  of  the  disease,  and,  especially  under  the  circum- 
stances mentioned  in  paragraph  4  of  Article  II,  the  measures  taken 
against  rats  and  mosquitoes. 

ARTICLE  V.  —  The  prompt  and  faithful  execution  of  the  preced- 
ing provisions  is  of  the  very  first  importance. 

The  notifications  have  only  a  real  value  if  each  government  is 
warned  in  time  of  cases  of  plague,  cholera  and  yellow  fever,  or  of 
suspicious  cases  of  those  diseases  occurring  in  its  territory.  It  can- 
not then  be  too  strongly  recommended  to  the  various  governments  to 
make  obligatory  the  declaration  of  cases  of  plague,  cholera  or  yellow 
fever,  and  the  giving  of  information  concerning  an  unusual  mortality 
of  rats  and  mice  especially  in  ports. 


784  MILITARY    HYGIENE. 

ARTICLE  VI.  —  It  is  understood  that  neighboring  countries  reserve 
to  themselves  the  right  to  make  special  arrangements  with  a  view  of 
organizing  a  service  of  direct  information  between  the  chiefs  of 
administration  upon  the  frontiers. 

ARTICLE  VII.  —  Information  of  a  first  case  of  plague,  cholera  or 
yellow  fever  does  not  justify,  against  a  territorial  area  where  it  may 
appear,  the  application  of  quarantine  measures. 

Upon  the  occurrence  of  several  non-imported  cases  of  plague,  or 
a  non-imported  case  of  yellow  fever,  or  when  cases  of  cholera  form 
a  focus,  the  area  is  to  be  declared  infected. 

ARTICLE  VIII.  —  To  limit  the  measures  to  the  affected  regions 
alone,  governments  should  only  apply  them  to  persons  and  articles 
proceeding  from  the  contaminated  or  infected  areas. 

*  *  2fc  *  * 

But  this  restriction  should  only  be  accepted  upon  the  formal  con- 
dition that  the  government  of  the  infected  country  shall  take  neces- 
sary measures,  i,  to  prevent,  unless  previously  disinfected,  the  expor- 
tation of  articles  coming  from  the  contaminated  area  and,  2,,  to  pre- 
vent the  extension  of  the  epidemic;  and  provided  further,  there  be 
no  doubt  that  the  sanitary  authorities  of  the  infected  country  have 
faithfully  complied  with  Article  I. 

When  an  area  is  infected,  no  restrictive  measure  is  to  be  taken 
against  departures  from  this  area  which  have  occurred  five  days  at 
least  before  the  beginning  of  the  epidemic. 

ARTICLE  IX.  —  That  an  area  should  no  longer  be  considered  as 
infected,  official  proof  must  be  furnished : 

First,  that  there  has  been  neither  a  death  nor  a  new  case  of  plague 
or  cholera  for  five  days  after  isolation,  death,  or  cure  of  the  last 
plague  or  cholera  case.  In  the  case  of  yellow  fever  the  period  shall 
be  eighteen  days,  but  each  government  may  reserve  the  right  to 
extend  this  period. 

Second,  that  all  the  measures  of  disinfection  have  been  applied ; 
in  the  case  of  plague,  that  the  precautions  against  rats,  and  in  the 
case  of  yellow  fever  that  the  measures  against  mosquitoes,  have  been 
observed. 

ARTICLE  X.  —  The  government  of  each  country  is  obliged  to  im- 
mediately publish  the  measures  which  it  believes  necessary  to  take 
against  departures  either  from  a  country  or  from  an  infected  terri- 
torial area. 


QUARANTINE.  785 

ARTICLE  XI.  —  There  exists  no  merchandise  which  is  of  itself 
capable  of  transmitting  plague,  cholera,  or  yellow  fever.  It  only 
becomes  dangerous  in"  case  it  is  soiled  by  pestous  or  choleraic  pro- 
ducts, or,  in  the  case  of  yellow  fever,  when  such  merchandise  may 
harbor  mosquitoes. 

ARTICLE  XII.  —  No  merchandise  or  objects  shall  be  subjected  to 
disinfection  on  account  of  yellow  fever,  but  in  cases  covered  by  the 
previous  article  the  vehicle  of  transportation  may  be  subject  to  fumi- 
gation to  destroy  the  mosquitoes.  In  the  case  of  cholera  and  plague, 
disinfection  should  only  be  applied  to  merchandise  and  objects 
which  the  local  sanitary  authority  considers  as  infected. 

Nevertheless,  merchandise  or  objects  may  be  subjected  to  disin- 
fection, or  prohibited  entry,  independently  of  all  proof  that  they 
may  or  may  not  be  infected. 

***** 

ARTICLE  XIII.  —  In  the  case  of  cholera  and  plague  there  is  no 
reason  to  forbid  the  transit  through  an  infected  district  of  merchan- 
dise and  objects  which  are  so  packed  that  they  are  not  exposed  to 
infection  in  transit. 

In  like  manner,  when  merchandise  or  objects  are  so  transported 
that,  in  transit,  they  cannot  come  in  contact  with  soiled  objects,  their 
transit  across  an  infected  territorial  area  should  not  be  an  obstacle 
to  their  entry  into  the  country  of  destination. 

***** 

ARTICLE  XVI.  —  Letters  and  correspondence,  printed  matter, 
books,  newspapers,  business  papers,  etc.  (postal  parcels  not  in- 
cluded), are  not  to  be  submitted  to  any  restriction  or  disinfection. 
In  case  of  yellow  fever,  postal  parcels  are  not  to  be  subjected  to 
any  restriction  or  disinfection. 

***** 

ARTICLE  XIX.  —  Baggage.  In  the  case  of  soiled  linen,  bed  cloth- 
ing, clothing  and  objects  forming  a  part  of  baggage  or  furniture 
coming  from  a  territorial  area  declared  infected,  disinfection  is  only 
to  be  practised  in  cases  where  the  sanitary  authority  considers  them 
as  contaminated.  There  shall  be  no  disinfection  of  baggage  on 
account  of  yellow  fever. 


BIBLIOGRAPHICAL  LIST  OF  THE  MORE  RECENT  AND 
USEFUL  WORKS  OF  HYGIENE. 

MILITARY  HYGIENE. 
Aitken,  Sir  Win.: 

Growth  of  the  recruit  and  young  soldier.     12°,  London 

1887. 
Ashburn,  P.  M.: 

The   elements   of  military   hygiene,    especially   arranged 
for  officers  and  men  of  the  line.     12°,  New  York, 
1909. 
Burot,  F.  &  Legrand,  M.  A.: 

Les    troupes    coloniales;    hygiene    du    soldat    sous    les 

tropiques.     8°,  Paris,  1898. 
Caldwell,  R.: 

Military  hygiene.     2  ed.     8°,  London  &  New  York,  1910. 
Davies,  A.  M.: 

Handbook  of  hygiene.     16°,  London,  1895. 
Duncan,  A.: 

The   prevention   of   disease   in    tropical    and    subtropical 

campaigns.     8°,  London,  1888. 
Firth,  R.  H.: 

Military   hygiene;    a   manual   of   sanitation   for   soldiers. 

8°,  London,  1908. 
Freeman,  E.  C.: 

The  sanitation  of  British  troops  in  India.     12°,  London, 

1899. 
Friedheim  &  Richter: 

Taschenbuch   fur  den   Felddienst  des   Sanitats   offiziers. 

4°,  Berlin,  1899. 
Havard,  V.: 

Manual  of  military  hygiene.     3  ed.,  8°,  New  York,  1917. 
Hoffmann,  W.  &  Schwiening,  H.: 

Hygiene    der   militarischen    Unterkiinfte;     Hygiene    des 

Dienstes.    8°,  Berlin,  1911. 
Keefer,  F.  R.: 

A  text  book  of  military  hygiene  and  sanitation.     Phila- 
delphia, 1914. 
Kirchner,  M.: 

Lehrbuch    der    Militargesundheitspflege.      2    Aufl.    der 
"  Grundriss     der     Militargesundheitspflege."      4°, 
Leipzig,   1910. 
Laveran,  A.: 

Traite  d'hygiene  militaire.     8°,  Paris,  1896. 
Melville,  C.  H.: 

Military  hygiene  and  sanitation.     8°,  London,  1912. 
Morache,  G.: 

Traite  d'hygiene  militaire.    2  ed.,  8°,  Paris,  1886. 

787 


788  MILITARY    HYGIENE. 

Morrison  &  Munson: 

A  study  in  troop  leading  and  management  of  the  sani- 
tary service.     Fort  Leavenworth,  Kans.,  1910. 
Munson,  E.  L.: 

The  theory  and  practice  of  military  hygiene.     8°,  New 
York,  1901. 

The  soldier's  foot  and  the  military  shoe.     Fort  Leaven- 
worth,  1912. 
Niehaus,  W.: 

Die    Sanitats    ausriistung    des    Heeres    im    Kriege.       8°, 

Berlin,  1913. 
Parkes,  E.  A.: 

A  manual  of  practical  hygiene,  prepared  especially  for 
use    in    the    medical    service    of    the    army.     8    ed. 
edited  by  J.  Lane  Notter.     8°,  London,   1891. 
Rouget  &  Dopter: 

Hygiene  militaire.     8°,  Paris,  1906. 

Tournade,  A.:   La  pratique  de  1'hygiene  en  campagne.     1916. 
Troussaint  &  Schneider,  G.  E.: 

Pages   d'hygiene   militaire   pour   les   officiers.     8°,   Paris. 
Viry,  C.  M.  J.: 

Principes  de  1'hygiene  militaire.     8°,  Paris,  1896. 
Woodhull,  A.  A.: 

Military  hygiene  for  officers  of  the  line.     8°,  New  York, 
1909. 

NAVAL  AND   MARINE  HYGIENE. 

Duchateau,  Jan  et  Plante: 

Hygiene  navale.     8°,  Paris,  1908. 
Fonssagrives,  J.  B.: 

Traite  d'hygiene  navale.     2  ed.,  8°,  Paris,  1877. 
Gatewood,  J.  D.: 

Naval  Hygiene.     Phila.,  1909. 
Germany : 

Kaiserliches    Gesundheitsamt.      Anleitung    zur  Gesund- 

heitspflege    an    Bord    von    Kauffahrteischiffen.      2 

Aufl.,  12°,  Berlin,  1899. 

Marinesanitatsordnung.     3  vols.,  8°,  Berlin,  1893. 
Holt,J.: 

An  epitomized  review  of  the  principles  and  practice  of 

maritime  sanitation.     8°,  New  Orleans,  1892. 
Plumert,  A.: 

Gesundheitspflege  auf  Kriegsschiffen.     2  Aufl.,  8°,  Wien 
&  Berlin,  1900. 


BIBLIOGRAPHY.  789 

GENERAL  HYGIENE. 
Abbott,  A.  C.: 

The  hygiene  of  transmissible   diseases;  their  causation, 
modes  of   dissemination  and   methods   of  preven- 
tion.   8°,  Phila.,  1899. 
Abel,  P.: 

Grundriss  der  Hygiene.     8°,  Berlin,   1912. 
Albrecht  (&  al.) : 

Handbuch  der  Hygiene.     10  vol.,  Jena,  1893-1901. 
Arnould,  J.: 

Nouveaux    elements    d'hygiene.     Entierement    refondus 

par  E.  Arnould.     5  ed.,  8°,  Paris,  1907. 
Bergey,  D.  H.: 

The  principles  of  hygiene.     4  ed.,  8°,   Phila.,   1912. 
Billings,  J.  S.: 

Principles  of  ventilation  and  heating.     New  York,  1886. 
Brouardel,  P.,  Chantemesse,  A.  &  Mosny,  E.: 

Traite    d'hygiene.       Public   en   20   fascicules.     8°,    Paris, 

1906-1913. 
Carpenter,  R.  C.: 

Heating  and  ventilation  of  buildings.     5  ed.,  New  York, 

1902. 
Chapin,  C.  V.: 

The  sources  and  modes  of  infection.     New  York. 
Chittenden,  R.  H.: 

Physiological  economy  in  nutrition.     8°,  1904. 

Nutrition  of  man.     8°,  1907. 
Cimmino,  R.: 

Appunti  di  igiene.     8°,  Napoli,  1905. 
Combastel,  G.: 

Elements   d'hygiene   pratique   a  1'usage   des   ecoles   nor- 
males,  des  instituteurs  et  des  families.     12°,  Paris, 
1902. 
Currier,  C.  G.: 

Outlines  of  practical  hygiene.    5  ed.,  8°,  New  York,  1905. 
Daniels,  C.  W.  &  Wilkinson,  E.: 

Tropical   medicine   and   hygiene.     3  vol.,  8",   London    & 

New  York,  1910-1912. 
De  Giaxa,  V.: 

Compendio  d'igiene.     4  ed.,  8°,  Milano. 
Dieudonne,  A.: 

Bacterial  food  poisoning.     New  York,  1009. 
Doane,  R.  W.: 

Insects  and  disease.     New  York,  1912. 


790  MILITARY    HYGIENE. 

Drasche,  A.: 

Bibliothek  der  gesammten  medicinischen  Wissenschaften 
fur  praktische  Aerzte  and  Specialaerzte.     Hygiene. 
8°,  Wien  &  Leipzig,  1899. 
Duchesne,  L.: 

Hygiene  generale  et  hygiene  industrielle.    8°,  Paris,  1896. 
Egbert,  S.: 

A  manual  of  hygiene  and  sanitation.     8°,  5   ed.,   Phila., 


Ferguson,  R.  B.: 

Aids  to  the  mathematics  of  hygiene.    4  ed.,  16°,  London, 

1909. 
Fisher,  B.: 

Kurzgefasste  Anleitung  zu  den  wichtigeren  hygienischen 

Untersuchungen.     2  Auf.,  8°,  Berlin,  1912. 
Fliigge,  C.: 

Grundriss    der    Hygiene   fur    Studirende    und    praktische 

Aerzte.     4  Auf.,  8°,  Leipzig,  1897. 
Folwell,  A.  P.: 

The  designing,  construction  and  maintenan.ee  of  sewer- 

age systems.     6  ed.,  8°,  New  York. 
Fuller,  G.  W.: 

Sewage  disposal.     New  York,  1912. 
Gartner,  A.: 

Leitfaden    der    Hygiene    fur    Studirende,    Aerzte,    Archi- 
tekten,     Ingenieure    und    Verwaltungsbeamte.       5 
Auf.,  8  ,  Berlin,  1909. 
Gerhard,  W.  P.: 

The   water   supply,   sewerage   and   plumbing  of  modern 
city  buildings.     New  York,  1910. 

Guide  to  sanitary  inspections.      4  ed.,    12°,   New  York, 

1909. 
Glaister,  J.: 

Manual  of  hygiene,  for  students  and  nurses.     2  ed.,  12°, 

Edinburgh,  1905. 
Greene,  A.  M.: 

Elements  of  heating  and  ventilation.     8°,  New  York. 
Guiraud,  L.: 

Manuel  pratique  d'hygiene  a  1'usage  des  medecins  et  des 

etudiants.     8°,  Paris,  1904. 
Harrington,  C.  &  Richardson,  N.  W.: 

A  manual  of  practical  hygiene.    4  ed.,  8°,  Phila.,  1911. 
Hazen,  A.: 

Filtration  of  public  water  supplies.     3  ed.,  8°,  New  York, 
1900. 


BIBLIOGRAPHY.  79! 

Clean  water.     New  York,  1907. 
Heim,  L.: 

Lehrbuch  der  Hygiene.     8°,  Stuttgart,  1903. 
Hooker,  A.  H.: 

Chloride  of  lime  in  sanitation.     8°,  New  York. 
Hough,  T.  &  Sedgwick,  W.  T.: 

Elements  of  hygiene   and   sanitation,   being  part   II   of 
"The     human     mechanism;     its     physiology     and 
hygiene   and   the   sanitation   of   its   surroundings." 
8°,'  Boston,  1907. 
Howard,  L.  O.: 

The  house-fly,  disease  carrier.     New  York,  1911. 
Kinnicut,  Winslow  &  Pratt: 

Sewage  disposal.    8°,  New  York,  1910. 
Kober,  G.  M.: 

Industrial  and  personal  hygiene.     Washington,   1908. 
La  Bonnardiere: 

Precis  d'hygiene  pratique  generate  et  speciale;  premiere 

partie,  hygiene  generale.     12°,  Lyon,  1001. 
Langlois,  J.  P.: 

Precis  d'hygiene  publique  et  privee.    4  ed.,  8°,  Paris,  1909. 
Leach,  A.  E.: 

Food  inspection  and  analysis.    2  ed.,  large  8°,  New  York, 

1009. 
Lehmann,  K.  B.: 

Die  methoden  der  praktischen  Hygiene.     Lehrbuch  zur 
hygienischen  Untersuchung  und   Beurtheilung  fiir 
Aerzte,  Chemiker  und  Juristen.    2  Auf.,  8°,  Wies- 
baden, 1901. 
Le  Play,  A.  &  Mesureur,  A.: 

Precis  d'hygiene.     8°,  Paris,  1909. 
Macaigne,  M.: 

Precis  d'hygiene.     8°,  Paris,  1911. 
Macfie,  R.  C.: 

Air  and  health.     New  York. 
Mason,  W.  P.: 

Water  supply.     3  ed.,  8°,  New  York. 

Examination  of  water.     4  ed.,  12°,  New  York. 
Notter,  J.  L.  &  Firth,  R.  H.: 

Hygiene.     6  ed.,  8°,  London,  1905. 
Pagliani,  L.:  • 

Trattato  di  igiene  e  de  sanita  publica  colle  applicazioni 
all'ingegneria  e  alia  vigilanza  sanitaria.  8°,  Milano, 
1005. 


792  MILITARY    HYGIENE. 

Parkes,  L.  C.: 

Hygiene  and  public  health.     5  ed.,  12°,  London,  1897. 
Pfeiffer,  R.  &  Proskauer,  B.: 

Encyklopadie     der     Hygiene.       Lfrg.     1-8,    8°,     Leipzig, 

1902-1903. 
Plicque,  A.  F.: 

Precis  populaire  d'hygiene  pratique.     12°,  Paris,   1902. 
Prausnitz,  W.: 

Grundziige    der    Hygiene    unter    Beriicksichtigung    der 
Gesetzgebung   des  deutschen    Reichs    und    Oester- 
reichs.     8  Auf.,  8°,  Munchen,  1908. 
Proust,  A.: 

Traite    d'hygiene.      3    ed.,    avec    la    collaboration    de    A. 

Netter  et  H.  Bourges.     8°,  Paris,  1904. 
Reid,  G.: 

Practical  sanitation;  a  handbook  for  sanitary  inspectors 
and    others    interested    in    sanitation.      8    ed.,    8°, 
London,   1901. 
Rideal,  S.: 

Disinfection  and  the  preservation  of  food.     8°,   London 
&   New   York. 

Sewage   and   bacterial   purification   of   sewage.     London. 
Rohe,  G.  H.: 

Text-book  of  hygiene.     3  ed.,  8°,  Phila.,  1899. 
Rosenau,  M.  J.: 

Preventive  medicine  and  hygiene.     Xew  York,  1913. 
Rubner,  M.: 

Lehrbuch   der   Hygiene;   systematische   Darstellung   der 
Hygiene    und    ihrer     wichtigsten     Untersuchungs 
methoden.     8  Auf.,  8°,  Wein,  1907. 
Rubner,  M.,  von  Gruber,  M.  &  Picker,  M.: 

Handbuch  der  Hygiene.     4  ed.,  Leipzig,   1911. 
Schoofs,  F.: 

Traite  d'hygiene  pratique;  methodes  de  recherches.     8", 

Paris,  1908. 
Sedgwick,  W.  T.: 

Principles  of  sanitary  science  and  public  health.     Boston, 

1902. 
Shaw,  W.  N.: 

Air   currents   and   the   laws   of  ventilation.      Cambridge 

Univ.  Press,  1907. 
Simpson,  W.  J.:  , 

The  principles  of  hygiene  as  applied  to  tropical  and 
sub-tropical  climates.  8°,  London  &  New  York, 
1908. 


BIBLIOGRAPHY.  793 

Smolensky,  P.: 

Traite   d'hygiene.      Precedes   rapides   de   recherche   des 
falsifications  et  alterations.    Traduction  du  russe, 
avec  annotations.     8°,  Paris,  1904. 
Smyth,  A.  W.: 

A    text-book    of    the    principles    of    hygiene,    based    on 
physiology.     For  the  use  of  school  teachers.     8°, 
London,  1905. 
Sternberg,  G.  M.: 

Report  on  building  of  model  houses.    Washington,  1908. 
Stevenson  &  Murphy: 

Treatise  on  hygiene.     3  vols.,  London. 
Thoinot,  L,  H.  &  Nordon: 

Hygiene.     8°,  Paris,  1911. 
Von  Esmarch,  E.: 

Hygienisches    Taschenbuch    fur    medizinal    und    verwal- 
tungsbeamte  Aerzte,  Techniker  und  Schulmanner. 
3  Auf.,  12°,  Berlin,  1902. 
Wanhill.  C.  F.  &  Beveridge,  W.  W.  O.: 

The    sanitary    officer's    handbook    of    practical    hygiene. 

8°,  London,  1909. 
Waring,  G.  E.: 

How  to  drain  a  house. 
Weill-Mantow,  J.: 

Hygiene     individuelle     et     economic     domestique.       12°, 

Paris,  1909. 
Whipple,  G.  C.: 

Microscopy  of  drinking  water.     Boston,  1905. 
Williams,  M.-. 

Chemistry  of  cookery. 
Wilson,  G.: 

A   handbook   of  hygiene   and   sanitary   science.      8  ed., 
12°,  London,  1898. 


INDEX 


Abdominal  band,  440,  704 
Acetone  bodies,  317 
Acetylene,  as  illuminant,  560 

field  outfit  for,  561 
Acids,  mineral,  as  disinfectants,  737 

vegetable,  as  food,  313 
Actinic  rays  and  their  action,  695 

effect  of  color  on,  697 
opacity  on,  697 

in  relation  to  clothing,  425 

in  water  purification,  282 
Actinomycosis  in  cattle  and  man,  326 
Administration  in  the  field,  683 
Aeroplane  in  war,  745 
Age,  as  influencing  sickness  and  mor- 
tality,  20 

in   relation   to   physical    develop- 
ment, 183 

of    applicants    for    enlistment    in 

U.  S.  Army,  183 
in  U.  S.  Navy,  755 
Air,  amount  of,  necessary,  531 

aqueous  vapor  in,  511 

composition  of,  509 

contamination  of,  519,  524 

cooling  of,  in  habitations,  706 

as  disinfectant,  719 

passage  of,  through  walls,  477,  536 

purification  of,  in  nature,  529 

sewer,  565 

symptoms  produced  by  pollution 

of,  524 

principal  causes  of,  524 
Air  space  necessary,  in  barracks,  531 

in  hospitals,  532 

on  board  ships,  756 
Airing  of  barracks,  492,  534 
Albuminoids  of  meat,  307 
Alcohol,  food  value  of,  414 

methylic  or  wood,  417 
Alcoholic  drinks,  414 

in  the  tropics,  694 

in  cold  climates,  714 
Alcoholism,  rates  for,  in  Army  and 
Navy,  131 

symptoms  and  effects  of,  416 
Altitude,  effects  of,  515 

in  the  tropics,  709 
Ammonia,  in  air,  511 

in  water,  267 

permissible  amount  of,  268 
Amoebae,  in  relation  to  dysentery,  47 


Ankylostomiasis,   108 

cause  and  symptoms  of,  108 
prophylaixs  of,  in 

Ankylostomum  duodenale,  108 

Anopheles  mosquitoes,  168 

Anthrax  in  man  and  cattle,  100,  327 

Antiseptic,  definition  of,  719 

Anti-siphon  trap,  572 

Antitoxins,  27 

Applicants  for  enlistment,  183 
age  limits  of,  in  Army,  183 

in  Navy,  755 

causes  of  rejection  of,  192 
chest  measurement  of,  189 
height  and  weight  requirements 

of,  187 

method  of  examination  of,  193 
relation      between      height      and 

weight  of,  191 

special  disqualifications  of,  197 
vision  and  hearing  requirements 

of,  195,  197 
in  the  Navy,  755 

Arnold  sterilizer,  721 

Ascaris  lumbricoides,  106,  107 

Asphyxiating  gases,  121 

Athlete's  heart,  220 

Athletic  games  and  races,  229 

Autogenesis,   26 

Aviation,  requirements  for,  197 

Bacillus,  definition  of,  23 

aerogenes  capsulatus,  14,  272 
anthracis,   100 
botulinus,  327 
bulgaricus,  315,  342 
coli  communis,  271 
comma,  51 
diphtheriae,   91 
of  Ducrey,  122 
dysenterise,  46 
enteritidis  (Gartner),  328 
enteritidis    sporogenes,    272 
lactis  aerogenes,  272 
leprse,  102 
mallei,  101 
paratyphosus,  42 
perfringes,  14 
pestis,  86 
prodigiosus,   263 
proteus  vulgaris,  328,  369 
pyocyaneus,  14 


795 


796 


INDEX. 


subtilis,  369 

tetani,  97 

tuberculosis,  56 
Bacon,  qualities  of,  322,  387,  402 

ration  of,  383 

Bacteria,  action  of,  on  proteins,  315 
on    carbohydrates,    317 

classification  of,  23 

denitrifying,   601 

effect  of  diet  on  intestinal,  369 

in  air,  521 

in  water,  270 

in  sewer,  565 

in  soil,  601 

introduction  of,  in  body,  27 

nitrifying,  580,  601 

of   putrefaction,   602 
Bake-ovens,  375 
Balantidium  coli,  48 
Ball  trap,  568 
Barber  shop,  hygiene  of,  248 

on  board  ships,  764 
Barrack  bag,  490 
Barracks,  arrangement  of,  474 

basement  of,  483,  485 

bedding  in,  490 

building  materials  of,  477,  483 

care  of,  492 

ceilings  of,  485,  532 

construction  of,  477,  483 

distribution  of  rooms  in,  485 

floors  of,  484,  493 

foundations  of,  480 

furniture  of,  489 

improvised,  624 

in  the  tropics,  705 

lavatory  in,  486 

orientation  of,  474,  475 

pavilion  system,  474 

plaster  finish  in,  480 

portable,  Ducker  system  of,  627 
Doecker  system  of,  627 

specifications  for.  483 

shape  and  size  of,  474 

Toilet  system  of,  474 

walls  of,  485 

windows  of,  482 
Barthelemy's  pack,  460 
Basements,  requirements  of,  479,  483 
Bathing  and  washing,  246 
Baths,  cold  and  warm,  252 

effects  of,  252 

shower  and  tub,  253 

Turkish  and  Russian,  253 
Battles,  sanitary  features  of,  745 

sanitary  precautions  before,  744 
Battlefield,  hygiene  of,  744 

disposal  of  the  dead  on,  748 


Beans  and  peas,  357 

Bedbug  as  disease  transmitter,  143 

destruction   of,   495 

Mexican,  144 
Bedding,  regulation,  490 
Bedsack  for  the  field,  490 
Bedstead,  regulation,  490 
Beef,  characteristics  of  good,  322 

corned,  335 

jerked,  335 

measly,  325 
Bell  trap,  568 
Belt,  cartridge,  468 
Benzin  as  insecticide,  181 
Benzoic  acid  as  preservative,  336 
Beriberi,  etiology  of,  115 

part  played  by  rice  in,   116 
Berkefeld  filter,  291 
Beverages,   alcoholic,  414 

proportion  of  alcohol  in,  416 
in  hot  countries,  694 
in  cold  countries,  714 

non-alcoholic,  409 
Bibliography,  787 
Bilge  water,  757 
Bilharziasis,   106 
Bivouacs,  603 
Blackwater  fever,  72 
Blanket,  regulation,  468,  490 
Blanket-roll,  461 
Blood  changes  in  tropics,  689 
Boiling,  as  means  of  disinfection.  720 
Borax,  as  food  preservative,  336 
Boston  vent  in  water-closets,  575 
Botulism,  327 
Bowels,  care  of,  255 

in  the  tropics,  709 
Bread,  characteristics  of  good,  354 

composition  of,  355 

fermented  and  non-fermented,  353 

field,   356 

hard,  355 

making  of,  354 

ration   of,   383 

soft,  355 

Break-bone  fever,  78 
Breathing,  in  exercise,  213 

through  the  nose,  213 
Brick,  as  building  material,  477 
Brill's  disease,  83 
Bromidrosis  of  feet,  249 
Bromin,  as  water  purifier,  282 
Broth  as  food,  331 
Bubble  fountain,  251 

in  the  Navy,  764 
Building   materials,   477 

permeability  of,  477 
porosity  of,  477 


INDEX. 


797 


Burial  of  bodies  on  battlefield,  749 
Butter  as  food,  345 
Buttermilk  as  food,  346 

Cabbage  as  food,  361 

Calories,  definition  of,  363 

Camps,  care  of  water-supply  in,  632, 

678 

concentration  of  troops  in,  583 
disposal  of  excreta  in,  636 

of  garbage  and  refuse  in,  666 
establishment  of,  632 
food  and  eating  in,  677 
form  of,  629 
improvements    in  installation   of, 

635 

laundry  and  lavatory  in,  666 

personal  hygiene  in,  680 

plan   of   infantry,  629 

poisonous  plants  in,  606 
animals  in,  609 

police  of,  681 

regimental  hospital  in,  631 

sanitation  of,  regulations  for,  684 

site  of,  603 

duration  of  occupancy,  682 
influence  of  vegetation  upon, 

606 
reasons   for  changing,  682 

soil  of,  605 

Campaign  or  service  hat,  436 
Campho-phenol   as   insecticide,   179 
Candles  as  illuminants,  559 
Canned  meat,  333 
Canteen  and  cup,  470 
Caps,  regulation,  435 

for  cold  regions,  439 

knitted,   night,   439 
Carbohydrates,  amount  necessary,  365 

composition  of,  311 

in  tropics,  403 

kinds  of,  311 

nutritive  functions  of,  317 
Carbolic  acid  as  disinfectant,  738 
Carbon  bisulphide  as  insecticide,  181 
Carbon  dioxid,  how  produced,  510 

as  air  constituent,  410 

as  index  of  air  pollution,  526 

effects  of,  525 

in  alveolar  air,  525 

reduction  of,  in  nature,  511 

tests  for,  in  air,  526 
Carbon  monoxid,  danger  from,  528 

in  coal  gas,  528,  560 

in  tobacco  smoke,.  528 

tests  for,  529 
Carriers  of  infections,  25 
Cartridge  belt,  468 


Cassava  as  food,  360 

Cellars,   requirements   of,  479 

Cellia  mosquitoes,  173 

Cellulose  as  food,  312 

Cerebro-spinal   meningitis,  90 

Charcoal  in  filters,  304 

Cheese  as  food,  346 

Chest,  effect  of  exercise  upon,  212 

how  to  expand,  213 

in  relation  to  height  and  weight, 
187 

method  of  measuring,  189 

mobility  of,  190 
Chicken-pox,   94 
Chimneys,  effects  of,  on  ventilation, 

539 

Chittenden's  experiments,  367 
Chloride  of  lime,  738 
Chlorine,  in  water,  267 

as  disinfectant,  727 

as  water  sterilizer,  283 
Chocolate,  composition  of,  412 

nutritive  value  of,  413 
Cholera,  etiology  of,  51 

prophylaxis  of,  52 

quarantine  regulations  in,  776 
Cigar  and  cigarette  smoking,  136 
Cistern,  for  rain  water,  258 

Venetian,  306 

Citric  acid  as  water  purifier,  289 
Clams  as  food,  337 
Clark's  process  for  hard  water,  265 

soap  test,  266 
Climatic  bubo,  103 
Climatic  variations,  686 
Clonorchis  endemicus,  106 
Clothing,  evaporation  of,  423 

fibers  used  for,  419 

heat  absorption  of,  421 

heat  conductivity  of,  422 

heat  radiation  of,  422 

hygroscopicity  of,  421 

in  cold  countries,  715 

in   relation   to   actinic   rays,   425, 
697 

in  the  tropics,  704 

outer,  424 

permeability  of,  420 

waterproofing  of,  432 

weight  of  materials,  410 
Coal  gas  as  illuminant,  559 
Coat,  regulation  dress,  428 

regulation  service,  429 
Cocaine  habit,  138 

Cockroaches   as   disease  transmitters, 
146 

species  of,  146 

destruction  of,  148 


798 


INDEX. 


Cocoa,  composition  of,  412 

effects  of,  413 
Coffee,  composition  of,  409 

effects  of,  409 

value  of,  in  field,  411 
Coindreau  strap  for  shoe,  445 
Cold,  effects  of  on  body,  713 
Cold  climates,  712 

campaigning  in,  712,  716,  746 

clothing  in,  715 

diet  in,  713 

diseases  of,  717 

stimulants  in,  714 
Cold  storage,  for  fish,  337 

for  meat,  332 

for  oysters,  338 

for  poultry,  333 
Colors  and  actinic  rays,  697 
Combustion,  effects  on  air  of,  523 
Conduction  of  heat,  544 
Congelation,    prevention    and    treat- 
ment of,  717 

Contact  filter  for  sewage,  584 
Contagious   diseases,  26 
Convection  of  heat,  544 
Cooking,  effects  of,  328 

of  meat,  modes  of,  328 
loss  in,  330 

in  the  field,  371 

in  foreign  armies,  377 

range,  for  the  field,  372 

outfit,  individual,  372 
Copper  sulphate  as  water  purifier,  288 
Cork  paint,  on  ships,  761 
Corn  or  maize  as  food,  356 
Cot,  regulation,  folding,  634 
Cotton  as  material  for  clothing,  424 
Cotton  khaki,  why  discarded,  429 
Cow  pea  as  food,  357 
Cremation   of   bodies   on   battlefield, 

749,  75i 
Crematories  for  garbage  and  refuse : 

the  rock-pile,  for  camps,  672 

the  grate,  for  garrison,  594 

(see  Incinerators) 
Creolin,  738 

Cresols  as  disinfectants,  738 
Crowding,  effects  of,  524,  680 
Crustaceans  as  food,  338 

composition  of,  339 
Culex  mosquitoes,  165 
Cuspidors  in  barracks,  494 
Cyanid  gas,  180 

see  hydrocyanic  acid,  180 
Cycloleppteron  mosquitoes,  171 
Cysticercus  bovis,  324 

cellulosae,  324 


Dakin's  solution,  739 
Dampness,    influence   on  health,   473, 
598 

in  new  buildings,  478 

in  cellars,  479 

on  ships,  761 
Darnall,  filter,  300 

water  purification  by  chlorin,  284 
Datura  or  Jimson  weed,  as  insecticide, 

178 
Deaths  in  U.  S.  Army,  4 

in  U.  S.  Navy,  4 

in  United  States,  5 
Dengue,  78 

Deodorant,  definition  of,  719 
Desiccation    as    means    of    preserva- 
tion, 335 

as  means  of  disinfection,  720 
Dew  point,  512 
Diarrhea,  causes  of,  45 

prevalence  of,  in  camps,  44 
Diet,  the  ideal,  366,  370 

(see  Food) 
Diphtheria,  91 
Disconnecting  trap,  568 
Diseases,  as  influenced  by  age,  2O 

infectious,  nature  of,  23 

in  time  of  peace,  3 

in  war,  n 

miscellaneous,  120 

most  prevalent  and  fatal,  3 

nutritional,  114 

of  tropical  countries,  15,  710 

of  cold  countries,  717 

parasitic,  105 

Diseases  of  cattle  and  hogs,  324 
Diseases    and    wounds,    losses    from, 

compared,  8 

Disease-transmitting  animals,    141 
Disinfectant,  air  and  light  as,  719 

definition  of,  719 

heat  as,  720 

steam  as,  721 
Disinfectants,  chemical,  gaseous,  727 

in  solution,  736 
Disinfecting  apparatus,  steam,  724 

steam  and  formaldehyde,  735 
Disinfection,  nature  of,  719 

in  the  field,  742 

of  feces,  743 

of  hands,  742 

of  latrines,  648 

of  rooms,  740 

of  sewage  effluent,  585 

of  ships,  766 

of  sputum,  74C 

of  urine,  743 


INDEX. 


799 


Draft,  nature  and  effects  of,  543 
Drain  in  house  plumbing,  565 

trapping  of,  567 
Drawers,   regulation,  433 
Dress  coat,  uniform,  428 
Dress  trousers,  uniform,  428 
Drinking  cup,  251 
Drinks,  see  Beverages 
Dry  heat  as  disinfectant,  720 
Dugout  as  winter  quarters,  625 
Dust,  atmospheric,  517 

microbial,  521 

in  air  contamination,  520 

in  relation  to  heating,  554 
Dysentery,  etiology  of,  45 

types  of,  46 

prophylaxis  of,  49 

Ear,  hygiene  of,  248 

protection  of,  755 
Earth,  absorbent  power  of,  602 
Earth-closet,  656 

earth  to  be  used  in,  656 
Eating  and  drinking,  rules  in,  406 
Eggs  as  food,  347 
Electricity  as  illuminant,  562 
Emergency  ration,  389 

of  the  British  army,  394 
of  foreign  armies,  395 
Entamoeba  coli,  47 
histolytica,  47 
tetragena,  47 
Entamebic  dysentery,  47 
Equipment,  requirements  of,  453 
distribution  of,  on  body,  455 
weight  of,  453 
U.  S.  Army,  461 

composition    and   weight    of, 

462 

for  cavalry,  471 
for  hospital  corps,  471 
Equitation  as  exercise,  226 
Examination  of  applicants,  193 
Excavating  wagon  for  excreta,  655 
Excreta,  amount  discharged,  564 
as  cause  of  infection,  636 
composition  of,  564 
danger  from,  636 
disposal  of,  in  camp,  636 
by  earth-closet,  656 
by  incineration,  658 
by  post  holes,  653 
•by  sink,  640 

by  sub-surface  irrigation,  591 
by  trenches,  637 
nature  of,  564 
Exercise,  object  of,  201 
effect  of,  on  heart,  210 


on  height,  216 

on  lungs,  212 

on  muscles,  209 

on  skin,  215 

on  temperature,  202 

on  weight,  216 
fatigue  from,  207 
forms  of,  206 
in  the  tropics,  688,  708 
in  cold  countries,  713 
lactic  acid  in,  203 
overtraining  in,  219 
physiology  of,  201 
regulation  of,  218 
Exercises,  special  military,  225 

the  setting-up,  225 
Extractives  in  meat,  310 

Falk's  winter  quarters,  624 
Fatigue,  nature  of,  207 
Fatigue  suit,  canvas,  430 
Fats,  amount  necessary,  365 

composition  of,  311 

digestibility  of,  322 

nutritive  functions  of,  316 

reduction  of,  in  tropics,  402 
Feet,  care  of,  242,  249 

deformity  of,  from  shoes,  442 
Fencing  as  exercise,  226 
Ferrous  sulphate  as  disinfectant,  740 
Field  baking,  375 

cooking,  371 

kitchen,  677 

lavatory,  666 

mess-shelter,  678 

ovens,  375 

range,  372 
Field  hospital,  632 
Filariasis,  105 
Filters,  water,  Berkefeld,  291 

Cincinnatus,  292 

Darnall,  300 

double-barrel,  305 

granular,  304 

improvised,  305 

Japanese,  303 

Jewell,  gravity,  297 

mechanical,  297 

Pasteur-Chamberland,  291 

pressure,  298 

rain  water,  258 

sand-bed,  294 

Filtration  of  water,  sand-bed,  293 
mechanical,  297 

air-wash  system,  298 
rake  system,  298 
nature  of,  290 

of  sewage,  581 


8oo 


INDEX. 


by  contact  filter,  584 
by  sand  bed,  583 
by  sprinkling  filter,  584 
Fireless  cooker,  374 
Fireplace,  heating  by,  546 
First-aid  packet  and  pouch,  471 
Fish  as  food,  337 

as  larva  destroyers,  176 
Flannel,  properties  of,  423 
Flask  trap,  567 

Fleas,  as  disease  transmitters,  145 
species  of,  145 
destruction  of,  146 
Flies,  as  disease  transmitters,  148 
in  cholera,  52 
in  dysentery,  49 
in  typhoid  fever,  34 
in  tuberculosis,  57 
breeding  of,  150 
modes    of    conveying     infections, 

152 
prevention    and    destruction    of, 

154 

species  of,  house-fly,   148 
biting  stable-fly,  156 
common  flies,  156 
flesh  or  blow  flies,  157 
horse-flies,  157 
phlebptomus  flies,  158 
simulium  flies,  157 
Floors,    construction    and    materials 

of,  481,  484 
dressing  for,  482,  494 
hygiene  of,  493 
Floor  space,  in  barracks,  532 
Floor  trap,  568 
Flour,  wheat,  352 

characteristics  of  good,  353 
grades  of,  352 
proteins  of,  353 
Flukes,  in  meat,  326 
Fluorescin  in  testing  wells,  262 

as  test  for  death,  749 
Food,  amount  required,  365,  370 
decrease  of,  southward,  401 
digestibility,  321 
dynamic  action  of,  401 
in  the  tropics,  400,  693 
in  cold  countries,  713 
on  board  ships,  765 
Foods,  classification  of,  307 

animal,  classification  of,  318 
composition  of,  319,  339 
cooking  of,  328 
excess  of,  367 

proximate  principles  of,  307 
nutritive  functions  of,  314 
nutritive  value  of,  363 


nitrogenous  constituents  of,  307 
vegetable,  classification  of,  349 

composition  of,  350 
Foot,  anatomical  lines  of,  441 
how  measured  for  shoes,  *\\\ 
military  type  of,  444 
Football  as  exercise,  231 
Foot-wear,  importance  of,  441 
effects  of  bad,  442 
in  cold  countries,  715 
(see  Shoes) 

Foot-and-mouth  disease,  327 
Forbes  water-sterilizer,  274 

transportable  sterilizer,  279 
Forests,  influence  of,  on  climate,  515 
Formaldehyde  as  disinfectant,  728 
generation  of,  by  autoclave,  730 
by  formalin  and  permangan- 
ate, 730 
by  lamp,  730 

by  Munson's  method,  732 
by  paraform,  731 
by    paraform     and    perman- 
ganate, 732 
by  retort,  729 
by  sheet  spraying,  731 
by  simple  spraying,  735 
by  steam  chamber,  735 
as  insecticide,  181 
Formalin  as  disinfectant,  736,  737 
Fort     Benjamin     Harrison,     sewage 

plant  of,  587 

Fort  Ethan  Allen,  plan  of,  476 
Foundations  of  buildings,  480 
Frambcesia  (yaws),  103 
Freezing,  effect  of,  on  organisms  in 

water,  280 
Frost-bite,   nature  and  treatment  of, 

713,  717 
Fruits  as  food,  361 

used  as  vegetables,  361 
Fuchsins  as  disinfectants,  740 

Gangosa,  126 

Garbage,  disposal  of,  593 

in  camps,  667 
Gas,  coal,  composition  of,  559 

products  of  combustion  of,  560 
Gas  gangrene,  15 
Gasolin  as  insecticide,  181 
Gauntlets,  uniform,  439 
Gelatinoids,  310 

nutritive  functions  of,  315 
Glanders,  in  man  and  horses,  101 
Gloves,  uniform,  439 
Gonorrhea    (see    Venereal    diseases), 

122 
Grease,  clogging  of  pipes  by,  569 


INDEX. 


801 


trap,  569 

Green  vegetables,  361 
Griffith  water-sterilizer,  279 
Grippe  or  influenza,  96 
Ground  air,  598 

moisture,  598 

temperature,  599 

water,  605 

Ground,  danger  of  sleeping  on,  635 
Guarana  as  beverage,  413 
Guard-house,  care  of,  493 
Gymnasium,  hygiene  of,  227 
Gymnastic  exercises,  221 

Hallux  valgus,  443 
Hair,  care  of,  247,  248 
Hands,  washing  of,  256,  742 
Hard  bread,  355 
Hat,  campaign  or  service,  436 
Havelock,  of  helmet,  435 
Haversack,  465 
Head  covering,  433 

in  cold  countries,  717 
Hearing,  examination  of,  197,  755 
Heart,  diseases  of,  120 

effect  of  exercise  on,  210 

effect  of  overstrain  on,  220 

examination  of,  198 

irritability  of,  244 
Heat,  as  disinfectant,  720 

loss  of,  from  body,  364 

effects  of  dry,  545 
moist,  688 

effects  of,  on  air  dust,  554 

of  flame,  559 

transmission  of,  544 
Heat-exhaustion,  704 
Heat-stroke,  703 
Heating,  by  hot-air  furnace,  549 

by  hot  water,  550 

by  open  fire  or  grate,  546 

by  steam,  551 

by  stoves,  547 

coils,  location  of,  552 

systems  of,  553 

direct  system  of,  553 

direct-indirect  system  of,  553 

drying  of  air  from,  545 

indirect  system  of,  553 

of  ships,  760,  761 

use  of,  in  ventilation,  546 
Height,  regulation,  for  soldiers,  187 
Helmet,  as  head  covering,  435 
Hematuric  fever,  72 
Hemoglobinuric  fever,  72 
Henneberg,  trinkwasser  wagon,  278 
Heroin,  139 
Hila  monster,  612 


Hookworm,  108 

old  world,  108 

new  world,  109 
Horse  meat,  322 
Hospital,  air  space  required  in,  532 

construction    and    disposition   of, 
498 

floors  and  walls  of,  500,  502 

field,  632 

general,  503 

temporary,  505 
pavilions  of,  506 

regimental,  631 

standard  post,  498 
brigade,  502,  503 
in  tropics,  503 
Hospital  ship,  770 
Hospital  tropical  tent,  620 

ward  tent,  622 
Hot  air,  heating  by,  549 
Hot  water,  heating  by,  550 
Humidifiers,  546 
Humidity  of  air,  513 

effect  of,  on  body,  513 

effect  of,  in  cold  weather,  514 

effect  of,  in  hot  weather,  514 

indoor,  545 

of  ships,  760 
Humus,  nature  of,  597 
Huts,  log,  624 

excavated  or  dugouts,  625 
Hydric  trap,  572 
Hydrocarbons  or  fats,  311,  322,  402 

functions  of,  316 
Hydrocyanic  acid  as  insecticide,    180 

in  disinfection  of  ships,  766 
Hydrophobia,  99 
Hygiene,  nature  and  scope  of,  XV 

military,  scope  and  aims  of,  XVIII 

of  battlefield,  744 

of  toilet  rooms,  576 
Hygroscopicity  of  fabrics,  421 
Hymenolepis  nana,  106 

Ice,  ration  of,  386 
Ice-cream,  344 
Identification  record,  200 

tag,  462,  749 
Illuminants,  559 

relative  cost  of,  563 

vitiation  of  air  by,  559 
Immunity,  nature  and  kinds  of,  28 
Imhoff  tank,  582 
Incineration  of  excreta,  658 

of  garbage  and  refuse.  668 
Incinerators  for  excreta,  658 

the  ambulant,  665 

the  Conley,  665 


802 


INDEX. 


the  Harris,  661 

the  Jones,  660 

the  Lewis  and  Kitchen,  665 

the  McCall,  658 

the  Q.  M.  Corps,  663 
Incinerators  for  garbage  and  refuse, 
668 

the  Caldwell,  672 

company  or  kitchen,  668 

the  Guthrie,  671 

rock-pile,  672 

railroad-iron,  675 
Infection,  production  of,  26 
Infectious  diseases,  23,  680 

marked  decrease  of,  12 
Infirmary,  631 
Influenza,  96 
Inlets,  fresh  air,  541 
Insects  as  disease-transmitters,  143 

in  barracks,  494 
Insecticides,  178 
Insolation,  702 
Inspection,  physical,  127 

in  the  Navy,  764 
Interaction  of  food  and  work,  407 
Intercepting  trap,  568 
Intestinal  flora,  how  affected  by  diet, 

369 

Intestinal  parasites,   106 
Iodine  as  water  purifier,  283 
Irrigation  in  sewage  disposal,  581 
Irritable  heart,  244 
Itch  or  scabies,  112 

camp,   112 

dhobie,  112 

Japanese  field  cooking  stove,  378 

pocket  stove,  717 

filter,  303 

Jerusalem  artichoke  as  food,  359 
Jigger  or  sand  flea,  146 

Kala-azar,  103 

Kephir  as  food,  346 

Kidneys,  overstrain  of,  206,  221,  368 

Kit,  surplus,  465 

field,  465 
Kitchen,  care  of,  495 

ambulant,  378 

field,  677 

improvised,  in  camp,  371 
Kitchen  pit,  for  liquid  wastes,  667 
Knapsack,  457 
Kola  nut,  as  stimulant,  413 
Koumiss,  346 

Lactic  acid  in  muscle  and  blood,  203 
action  of,  204 


Latrines,  in  camp,  631,  636 

danger  from,  636 

disinfection  of,  648 

earth-closet,  656 

firing  of,  649 

pit  (see  Sinks),  640 

police  of,  648 

post-hole,  653 

sanitary  trough,  653 

spraying  of,  650 

trench,  637 
Latrine  box,  643 

the  Havard,  643 

the  Lyster,  645 

the  standard,  645 

the  Straub,  645 
Laundry  in  garrison,  254 

in  field,  666 
Lavatory  in  garrison,  250 

in  field,  666 
Leggins,  uniform,  450 
Leishmaniasis,  103 
Lentils  as  food,  357 
Leprosy,  102 

quarantine  regulations  in,  780 
Lice  as  disease  transmitters,  144 

destruction  of,  145 

species  of,  144 
Light  and  lighting,  557 

effects  of,  557 

location  of,  558 
Lime  as  disinfectant,  739 

bisulphide  as  insecticide,  181 

chloride   (chlorinated),  283 
as  disinfectant.  738 
as  water  purifier,  283 
as  sewage  sterilizer,  586 
in  treatment  of  wounds,  739 

hypochlorite,  283 

milk  of,  739 
Liquid  wastes,  disposal  of,  668,  670, 

671 
Liver,  abscess  of,  49 

effect  of  food  excess  on,  401,  693 

effect  of  alcohol  on,  416 
Lizards,  as  poisonous  animals,  612 
Lockers  for  squad-rooms,  490 
Lockjaw  or  tetanus,  97 
Log  huts,  624 
Luminosity  in  flame,  559 
Lysol,  738 

Maize  as  food,  356 

Malarial  fevers,  etiology  of,  64 
human  cycle  of  parasites  in,  65 
mosquito  cycle  of  parasites  in,  67 
parasites  of,  64 


INDEX. 


8o3 


prevalence  of,  63 

prophylaxis  of,  67,  71 
Malta  fever,  80 

Manchineel  as  poisonous  plant,  608 
Mansonia  mosquitoes,  167 
Manual  of  arms  as  exercise,  225 
Manure,  treatment  of,  154,  674 
March,  forced,  234 

general  remarks,  233 

rate  and  length  of,  237 

regulation  of,  237 

water  drinking  on  the,  239 
Marching,  flexion  step  in,  235 

in  the  tropics,  708 

steps  used  in,  234 

work  done  in,  244 
Marine  hygiene,  752 
Marshes  near  camps,  604 
Mate  as  beverage,  413 
Mattress,  regulation,  490 
Measles,  94 

German,  95 
Meat,  roasting  or  baking  of,  329 

boiling  of,  329 

broiling  of,  329 

canning  of,  333 

characteristics  of  good,  322 

composition  of,  319 

constituents  of,  318 

cooking  of,  328 

desiccation  of,  335 

digestibility  of,  321 

extracts,  331 

extractives,  318 

frying  of,  330 

loss  by  cooking,  330 

parasites  of,  324 

poisoning  by,  327 

preservation  of,  331 

refrigeration  of,  332 

salting  of,  335 

stewing  of,  330 
Meat-can,  465 
Medical  officer,  status  of,  XIX 

duties  and  responsibilities  of,  XX 
Meningitis,  cerebro-spinal,  00 
Mercury,  bichloride  of,  as  disinfect- 
ant, 736 

as  insecticide,  181 
Merriam  pack,  459 
Mees,  company  and  general,  486 
Mess  kit,  individual,  462 
Mess-room,  care  of,  495 
Mess  shelter,  for  camps,  678 
Methylic  alcohol,  417 
Meyer  line  in  foot,  442 
Micro-organisms  in  air,  521,  522 
Milk,  as  medium  for  bacteria,  3-40 


composition  of,  340 

diseases  transmitted  by,  341 

dried  or  powdered,  344 

examination  of,  343 

lactic  bacilli  in,  342 

pasteurization  of,  344 

sterilization  of,  343 

toxic  substances  in,  341 
Milk  of  lime  as  disinfectant,  739 
Mites  as  disease  transmitters,  141 
Mittens,  regulation,  439 
Modern  warfare,  745 

prominent  features  in,  745 
Moisture  in  heated  air,  545 

in  walls  of  new  building,  478,  479 

in  soil,  598 
Mollusks  as  food,  337 

composition  of,  339 
Morbidity  and  mortality  in  military 
service,  I 

in  the  Navy,  4 

in  time  of  peace,  3 

in  tropical  countries,  15 

in  war,  6 

Morphine  habit,  138 
Mortality,  decrease  of,  XVI 

from   disease  and   wounds   com- 
pared, 8 

in  U.  S.  Army,  4 

in  U.  S.  Navy,  4 

influence  of  age  on,  20 

of  length  of  service  on,  20 
of  climates  and  stations  on,  20 
of  race  on,  18 
Mortar  and  plaster,  478 
Mosquitoes    as    disease    transmitters, 

!59 

classification  of,  158,  164 
description  and  breeding  of,   159 
destruction  of,  68,  174 
eggs  of,  1 60 

mode  of  conveying  infection,  160 
screening  against,  68,  681 

Mosquito  bars,  use  of,  68,  681 

Mountain  sickness,  515 

Mouras  vault,  589 

Mouth,  care  of,  247 

Mumps,  96 

Muscles,  effect  of  exercise  on,  209 

Mushrooms,    useful    and    poisonous, 
608 

Mutton,  characteristics  of,  322 

Myzomyia  mosquitoes,   171 

Myzorhynchus  mosquitoes,  172 

Native  forces,  use  of,  in  tropics,  693 


804 


INDEX. 


Naval  hygiene,  752 

characteristics  of,  752 

statistics  of,  753 
Necator  Americanus,  109 
Night  marches,  239,  708 
Night  urinals,  652 
Nitrates    in    water,    significance    of, 

269 
Nitrites    in    water,    significance    of, 

268 

Nitrogen  in  nature,  510 
Nitrogenous  diet,  excess  of,  368 
Non-effective  rates,  5 
Nucleo-protein,  308 
Nuts  as  food,  362 
Nyssorhyncus  mosquitoes,  172 

Oatmeal  as  food,  356 

Ocean,  influence  of,  on  climate,  515 

Oil,  linseed,  for  floors,  482 

Oil,  mineral,  for  lighting,  559 

for  destruction  of  mosquitoes,  175 

for  latrine  disinfection,  649 
Oleomargarin  as  food,  346 
Olive-drab  cotton  cloth,  429 
Olive-drab  flannel  shirt,  430 
Onions  as  food,  361 
Outlets,  ventilating,  541 
Ovens,  field,  for  baking,  375 

improvised,  376 
Overcoat,  regulation,  431 

for  cold  climates,  432 
Overshirts,  regulation,  433 
Overshoes,  regulation,  450 
Overstrain  in  exercise,  220 
Overtraining  in  exercise,  219 
Oxygen,  for  animals  and  plants,  509 
Oxygenation  of  blood,  effect  of  hot 
'climates  on,  690 

effect  of  high  altitudes  on,  515 
Oxyuris  vermicularis,  106 
Oysters  as  food,  337 
Ozone,  as  air  constituent,  511 

as  disinfectant,  736 

as  water  purifier,  281 

effect  of  heat  on,  554 

Pack-carrier,  465 

Pack,  composition  of,  462 

Pack,  Merriam,  459 

Pain  de  guerre,  French  army,  355 

Pain  biscuite,  French  army,  356 

Panama  Canal  Zone,  16 

rates  of  diesase  and  death,  16 

results  obtained  in,  692 
Papataci  fever,  81 
Papering,  walls  and  ceilings,  481 
Paragonomiasis,  106 


Parasites,  of  circulatory  system,  105 

intestinal,  106 

skin,  1 12 

Paratyphoid  fever,  42 
Pasteurization  of  milk,  343 
Pavilion  wards,  506 
Peanuts  as  food,  362 
Peas  as  food,  357 
Pectin  as  food,  312 
Pediculus,  species  of,  144 

destruction  of,  145 
Pellagra,  114 

Pemmican  as  food,  335,  714 
Pemphigus  contagiosus,  113 
Permanganate  as  water  purifier,  288 
Permeability  of  fabrics,  420 

of  soils,  597,  598 
Personal  hygiene,  246 

in  the  field,  680 

on  board  ships,  762 
Perspiration,  in  hot  climates,  687 
Petroleum,  as  illuminant,  559 

to  destroy  bedbugs,  495 

to  destroy  mosquitoes,  175 

to  disinfect  latrines,  649 
Phagocytosis,  27 
Physical  training,  22 1 

*  for  officers,  224 
Picket  line,  care  of,  674 
Pied  force,  242 
Pignet's  index,  191 
Pinole  as  food,  356 
Plague,  types  of,  85 

cause  of,  86 

diagnosis  of,  88 

mode  of  transmission,  86 

prophylaxis,  88 

quarantine  regulations,  777 
Plasmodium  parasites,  64 
Plaster  and  plastering,  478,  479,  480 
Plumbing  fixtures,  565 
Plumbing  system,  565 
Pneumonia,  62 
Poisonous  plants,  606 
Poisonous  animals,  609 
Police,  sanitary,  of  camps,  681 
Poncho  for  foot  soldiers,  468 
Pork,  characteristics  of  good,  322,  323 

measly,  324 
Portable,  knock-down  barracks,  627 

hospitals,  627 
Post,  military,  plan  of,  476 

disposition  of  buildings,  474 

site  of,  473 

Post  holes  for  excreta  disposal,  653 
Potassium    permanganate    as    water 

purifier,  288 
Potatoes  as  food,  358 


INDEX. 


805 


Preservatives,  food,  336 

Prismatic  glass  in  windows,  559 

Privy  (see  Latrines) 

the  L.  R.  S.  sanitary,  591 

Proteins,  amount  necessary,  365,  370 
bacterial  decomposition  of,  315 
composition  and  nature  of,  308 
danger  of  excess  of,  368 
digestibility  of,  321 
experiments  regarding,  367 
kinds  of,  307 
nutritive  functions  of,  314 
reduction  of,  reasons  for,  368 
in  the  tropics,  402,  693 

Protozoa,  24 

Proximate  principles  of  food,  306 

Psilosis  or  sprue,  50 

Ptomains,  327 

Pulses  as  food,  357 

Purin  bodies,  309 

Puttees,  450 

Pyrethrum  as  insecticide,  178 

Pyrofume  as  insecticide,  179 

Quarantine,  definition  and  object,  774 

interstate,  780 

maritime,  775 

municipal,  782 

camp  of  detention  in,  781 

sanitary  cordon  in,  781 
Quarantinable  diseases,  774 

special  regulations  for,  776-780 

(see  Sanitary  convention) 

Rabies  or  hydrophobia,  99 
Race,  influence  of,  18 
Radiation  of  heat,  544 

from  body  and  clothing,  364,  422 
Radiation,  solar,  517,  695 
Radiators,  location  of,  552 
Range,  cooking,  for  field,  372 
Ratio  of  killed  to  wounded,  14 
Ration,  Army,  383 

conclusions   regarding  the,  396 
emergency,  389 
field,  388 
Filipino,  388 
garrison,  383 

composition    of    components, 

3io 

value  in  calories,  384 
in  foreign  armies,  391 
British  army,  393 
Chinese  army,  398 
French  army,  391 
German  army,  393 
Japanese  army,  394 
Russian  army,  394 


in  the  tropics,  400 

conditions  affecting,  400 

reserve    (haversack),  387 

savings  of,  how  expended,  398 

trail,  390 

travel,  386 

U.  S.  Navy,  390 
Recruiting,  182 

(see  Applicants  for  enlistment) 

in  the  Navy,  755 
Recurrent  fever,  83 
Red  bug,  141 
Refrigeration,  332 

(see  Cold  storage) 
Refuse  in  camps,  disposal  of,  666 
Relapsing  fever,  83 
Respiration,  vitiation  of  air  by,  519 

in  the  tropics,  690 
Rhus  or  sumach,  606 
Rice  as  food,  357,  405 

in  etiology  of  beriberi,  116 

structure  and  composition  of,  116 
Ridge  ventilation,  539 
Ringworm,  112 

tropical,   112 

Rocky  Mountain  spotted  fever,  84 
Roofing  of  buildings,  483,  485 
Room  disinfection,  740 
Roots  as  food,  360 
Rubeola  or  measles,  94 
Rules  in  eating  and  drinking,  406 
Running  drill  as  exercise,  226 
Russian  ambulant  kitchen,  378 
Russian  stove,  548 

Saccharin,  312 
Salts,  mineral,  as  food,  314 
Sanatorium  for  tuberculosis,  60 
Sanitary  cart,  668 

Sanitary  convention  of  American  re- 
publics, 783 
Sanitary  inspector,  683 
Sanitary  rules  in  the  field,  677 
Sanitary  service,  regulation  of,  683 
Sanitary  squads,  684 
Sanitas  trap,  571 
Scabies  or  itch,  141 

cause  of,  141 
Scarlet  fever,  94 
Schistosomum,  species  of,  106 
Scorpions  as  venomous  animals,  612 
Screening  against  flies,  681 
Scurvy,  119 
Seal  of  traps,  567 

loss  of,  569 
Septic  tank,  581 

action  of,  581 

Tmhoff,  582 


8o6 


INDEX. 


Service  uniform,  429 
Service  at  the  front,  747 
Service  in  cold  climates,  712 

(see  Cold  climates) 
Service  in  warm  climates,  686 

(see  Tropics) 

Sewage,  biological  treatment  of,  580 
by  irrigation,  581 
by  filtration,  581,  583 

chemical  treatment  of,  579 

composition  of,  578 

definition  of,  564 

discharge  of,  into  the  sea,  578 
into  lakes  and  rivers,  579 

disinfection  of  effluent,  585 

disposal  of,  578 

in  garrison  and  camps,  586 

domestic  treatment  of,  589 

purification  plant,  587 

stability  of  effluent,  585 
Sewer  air,  nature  of,  565 
Sewerage,  definition  of,  564 

effects  of,  upon  health,  565 

requirements  of,  564 
Sewers,  combined  system  of,  577 

separate  system  of,  577 
Ships,  care  of  decks  on,  761 

causes  of  air  pollution  on,  757 

conditions    affecting   hygiene    of, 
752 

disinfection  of,  766 

humidity  of,  760 

personal  hygiene  on,  762 

sick  bay  of,  768 

temperature  of,  760 

ventilation  of,  758 

water-supply  of,  765 
Shirts,  433 

olive-drab  overshirt,  430 
Shoes,  breaking  a  new  pair  of,  445 

care  of,  448 

effects  of  ill-fitting,  /|/|2 

fitting  of,  444 

military,  444 

requisites  of,  447 

shape  of  rational,  446 

uniform,  449 
Shower  bath,  in  garrison,  253 

in  the  field,  666 
Sick  bay  of  ships,  768 
Six-day  fever,  81 
Sinks  or  pit  latrines,  box  for,  643 

construction  of,  640 

dimensions  of,  640 

location  of,  640 

objections  to,  651 

police  and  disinfection  of,  648 

use  of  paper  in,  648 


Siphonage  in  traps,  cause  of,  569 

prevention  of,  570 
Skin,  effects  of  washing  the,  246 

functions  of,  246 

parasites  of,   112 

pigment  of,  700 

vitiation  of  air  by,  520 
Sleeping  bag,  468,  716 
Sleeping  sickness,   104 
Slicker  for  mounted  troops,  468 
Smallpox  or  variola,  92 

quarantine  regulations  in,  779 
Smell,  in  air  pollution,  524,  526 
Smoking  habit,  133 
Snakes  as  poisonous  animals,  610 
Snake  bite,  treatment  of,  6n 
Snow  blindness,  558,  716 
Soap,  use  of,  247,  250,  742 
Socks,  regulation,  452 
Sodium  bisulphate  as  water  purifier, 

288 

Sodium  hypochlorite   as   water  puri- 
fier, 283 

Soft  drinks,  413 
Soil,  absorbent  power  of,  602 

air  in,  597 

bacteria  of,  601 

constituents  of,  597 

danger  of  sleeping  on,  635 

effect  of  vegetation  on,  600 

moisture  of,  598 

permeability  of,  to  water,   598 

pollution  of,  601 

porosity  of,  597 

temperature  of,  599 
Soil  pipe,  in  house  plumbing,  565 
Solanin  in  potatoes,  359 
Solar  rays,  nature  and  effects  of,  695 
Solaro  fabrics,  425 
Soup,  331 

Soy  bean  as  food,  358 
Spiders  as  poisonous  animals,  613 
Spirillum,  24 

of  cholera,  51 
Spirochsete    (treponema)    of  syphilis, 

122 

Spittoons,  use  and  care  of,  494 
Spring  water,  260 
Sprinkling  filter  for  sewage,  584 
Sprue  or  psilosis,  50 
Sputum,  danger  of,  494 

disinfection  of,  743 
Star  ventilator,  539 
Starches  as  food,  312 
Stations,  influence  of,   on  health,   20 
Steam  as  disinfectant,  721 

saturated  or  flowing,  721 

superheated,  723 


INDEX. 


8o; 


Steam  disinfecting  apparatus,  724 
Steam,  heating  by,  551 
Stegomyia  mosquitoes,   166 
Step,  the  flexion,  235 
Steps,  cadence  and  length  of,  234 
Sterilization,  definition  of,  719 
Stomoxys  calcitrans,  156 
Stove,  heating  by,  547 

ventilation  by,  547 

Russian,  548 

Japanese,  717 
Straddle  trench,  637 

cover  for,  639 
Streptococcus  fecalis,  14 
Strongyloides  stercoralis,  106 
Sub-surface  irrigation,  591 
Sugar,  cane,  or  saccharose,  312 

grape,  or  glucose,  311 

maltose,  311 

milk,  or  lactose,  312 

on  the  march,  240 

value  as  food,  317 
Sulphur  dioxid,  as  disinfectant,  728 

as  insecticide,  179 

as  preservative,  335 

method  of  generating,  728 
Sunlight,  as  disinfectant,  719 

in  the  tropics,  695 
Sunning  of  bedding,  720 
Sunstroke,  cause  and  effects  of,  702 
Surplus  kit,  465 
Suspenders,  for  soldiers,  426 
Sweater,  regulation,  431 
Sweet  potatoes  as  food,  360 
Swimming  as  exercise,  227,  763 
Swimming  pool,  hygiene  of,  228 
Symptomatic  anthrax,  101 
Syphilis,  cause  of,  122 

diagnosis  of,  125 

prophylaxis  of,  126 

statistics  of,  123 

from  tattooing,  764 

Tag,  identification,  462,  749 
Taenia  saginata,  324 

solium,  324 
Tannier  as  food,  360 
Taro  as  food,  360 
Tattooing,  danger  from,  764 
Tea,  composition  of,  410 

preparation  of,  410 

value  of,  in  the  field,  411 
Teeth,  care  of,  247 
Tempelhof  hospital,  Berlin.  507 
Temperature,  of  body,  in  tropics,  690 

of  air,  indoor,  545 

variations  of,  686 

of  ships,  760 


Tents,  common,  616 

conical,  617 

cooling  of,  707 

ditching  of,  633 

flooring  of,  615 

general  considerations,  614 

Herbet,  623 

hospital,  tropical,  620 

hospital  ward,  622 

pyramidal,  620 

shelter,  615 

shifting  of,  in  camp,  682 

spacing  of,  629 

storage,  623 

Toilet,  623 

tortoise,  623 

ventilation  of,  614 

wall,  large,  616 

small,  617 
Terrazo  floors,  481 
Tetanus  or  lockjaw,  97 
Textile  fibers,  419 
Three-day  fever,  81 
Ticks  as  disease  transmitters,  141 

species  of,  142 
Tinea  circinata  or  ringworm,  112 

imbricata   or  tropical    ringworm, 

112 

Tirotoxicon,  341 

Tobacco,  use  and  effects  of,  133 

composition  of,  133 
Toilet  of  the  soldier,  247 
Toilet  paper,  in  camps,  648 
Toilet  room,  hygiene  of,  576 
Toilet  pavilion,  474 
Tomatoes  as  food,  361 
Tonsillitis,  4,  555 
Tooth-powders,  248 
Toxins,  27 
Training,  physical,  221 

for  officers,  224 
Training  stations  in  Navy,  755 
Transports,  bunks  on,  757 

space  on,  756 

ventilation  of,  757 
Traps,  back-pressure  in,  570 

anti-siphon,  572 

common  forms  of,  567 

depth  of  seal  in,  567 

grease,  569 

loss  of  seal  in,  569 

non-siphoning,  571 

object  of,  567 

sanitas,  571 

siphonage  of,  569 

venting  of,  570 
Travel  ration,  386 
Trench  foot,  121,  747 


8o8 


INDEX. 


Trench  hygiene,  746 

Trenches  as  straddle  sinks,  637 

Treponema   (or  spirochsete),  24 

pallidum  of  syphilis,  122 

pertenue  of  yaws,  103 
Trichina  spiralis,  325 
Trichuris  trichiura  or  whipworm,  106 
Tricresol  as  disinfectant,  738 
Tropical  diseases,  15,  710 
Tropical  sore,  103 
Tropics,  barracks  in,  705 
cooling  of,  706 

beverages  in,  694 

blonds  and  brunettes  in,  701 

care  of  bowels  in,  709 

chilling  of  body  in,  708 

climatic  features  of,  687 

clothing  in,  704 

diet  for  the,  402 

effects  of  proteid  diet  in,  402 

exercise  in,  688,  708 

fats  in,  402 

food  in,  693 

danger  of  excess  of,  693 

glare  in,  557,  702 

head-gear  in,  704 

heat  dissipation  in,  687 

influence  of,  on  blood,  689 
on  nervous 'system,  691 
on  pulse,  690 
on  respiration,  689 
on  body  temperature,  690 
on  weight,  691 

length  of  service  in,  692 

marching  in,  708 

rarefaction  of  air  in,  690 

skin  pigmentation  in,  700 

tents  in,  707 

ventilation  of  barracks  in,  705 

water  cooling  in,  706 
Trough  latrine,  653 

advantages  and  objections,  655 
Trousers,  uniform,  428,  451 
Trypanosomiasis,  104 
Tse-tse  fly,  104,  156 
Tuberculosis,  cause  of,  56 

in  cattle,  326 

mode  of  infection  in,  57 

prevalence  of,  54 

prophylaxis  of,  58 

sanatorium  treatment  of,  59 
Tubers  as  food,  358 
Typhoid  bacillus,  30 

in  feces  and  urine,  31 

transmission  of,  32 
by  flies,  34 
by  contact,  33 
by  clothing  and  tentage,  33 


by  water,  34 
Typhoid  fever,  in  the  Army,  29 

prophylaxis  of,  38 

statistics  of,  36 

susceptibility  to,  37 

vaccination  against,  39 
Typho-malarial  fever,  30 
Typhus  fever,  81 

etiology  of,  82 

former  prevalence  of,  II 

quarantine  regulations  in,  779 

Ultra-violet  or  actinic  rays,  695 

in  water  purification,  282 

in  illumination,  558 
Underclothing,  requirements  of,  423 

materials  used  for,  423 

orange-red,  697 

regulation,  433 
Undershirts,   regulation,  433 
Uniform,  requirements  of,  426 

color  of  the,  426 
Uniforms  in  U.  S.  Army,  428 
Uric  acid,  excretion  of,  309 
Urinals,  in  camps,  652 

in  garrison,  576 

Urine,   danger  of,   in  typhoid    fever, 
3i 

disinfection  of,  743 

Vaccination,  in  smallpox,  92 

in  typhoid  fever,  39 
Vaillard-Desmaroux    sterilizer,   278 
Vapor  as  air  constituent,  511 
Varicella,  94 

Vaiicocele  in  applicants,  199 
Varicose  veins  in  applicants,  200 
Variola  or  smallpox,  92 
Varioloid,  93 
Vegetable  acids,  313 
Vegetable  foods,  classification  of,  349 

composition  of,  350 
Vegetables,  green,  361 

fruits  used  as,  361 
Vegetation,  effect  of,  on  air,  511 

on  camp  site,  606 

on  mosquitoes,  606 

on  soil,  601 
Venereal  diseases,  122 

in  the  tropics,  123,  710 

prophylaxis  of,  126 

rates  in  Army  and  Navy,  123 

in  foreign  armies,  124 
Venomous  animals,  609 
Ventilation,  nature  of,  519,  530 

artificial,  539 

advantages     and     objections, 
540 


INDEX. 


809 


downward  system,  540 
upward  system,  540 
effect  of  chimneys  on,  539 
effect  of  heat  on,  534 
effect  of  stoves  on,  539 
inlets  for,  541 

position  and  size  of,  541 
natural,  534 

devices  to  promote,  537 
forces  governing,  534 
on  board  ships,  756 
outlets  for,  541 

position  and  size,  541 
ridge,  539 

Ventilators,  kinds  of,  538 
Venting  of  traps,  570 
Vermin  in  barracks  494 
Vision  requirements,  in  Army,  195 

in  Navy,  775 

Vitality,  effect  of  service  on,  747 
Volunteers,  losses  by  disease  in,  182 

Wainscoting  in  barrack?,  490 
Walls,  dampness  of,  478,  479 
permeability  of,  477,  536 
plastering  and   finishing  of,  480, 

485 

thickness  of,  477 
Waring  system  of  disposal,  591 
Warm  climates,  686 

(see  Tropics) 

Wastes,  disposal  of,  593,  667 
Waste-pipes   in  house  plumbing,   565 
Water,  ammonia'  in,  267 

bacterial  indicators  in,  272 
bacterial  examination  of,  270 
chemical  examination  of,  264 
chlorine  in,  267 
distilled,  280 

drinking  of,  on  the  march,  239 
at  meal,  406 
in  the  tropics,  694 
evaporation  of,  to  cool  air,  706 
external  qualities  of,  263 
hardness  in,  265 
lake,  260 
.  metals  in.  266 

microscopic  examination,  270 
nitrates  in,  269 
nitrites  in,  268 
organic  matter  in.  266 
pathogenic  organisms  in,  271 
purification  of,  273 

by  chemical  means,  281 

by  cold,  280 

by  filtration,  290 

by  heat,  273 

by  sunlight,  260,  720 


quantity  of,  required,  257 

rain,  258 

river,  259 

self-purification  of,  259 

spring,  260 

sterilizers,  objections  to,  279 
the  Forbes,  274 
the  Griffith,  279 

wagon,  on  the  march,  241 

wheeled-sterilizers,  277 
Water  bag,  sterilizer,  286 
Water-closets,  fixtures,  572 

hopper,  574 

requirements  of;  572 

short-hopper,   574 

siphon-jet,  574 

wash-down,  574 

wash-out,  574 

Water-gas,  as  illuminant,  559 
Waterproofing  of  clothing,  432 

of  shoes,  448 
Water-supply,  in  camps,  632,  6/8 

on  board  ships,  765 
Water-wagons  ,241,  277 
Weight,  as  affected  by  exercise,  216 

for  applicants,  188 

in  relation  to  height,  189 

loss  of,  in  the  tropics,  691 
Wells,  construction  of,  261 

location  of,  262 

pollution  of,  261 

tubular,  263 

Welsbach  gas-burner,  560 
Wheat,  351 

flour  of.  352 
Wheeled  kitchen,  378 
Wheeled  water-sterilizers,  277 
White  duck  suit,  430 
Windows,  construction  of,  482 

double,  483 

French,  482 

ventilating  panels  in,  537 
Wood  alcohol.  417 
Woodvork,  disinfection  of,  741 
Wool  fiber,  419 
Woolen  fabrics,  advantages  of,  423 

objections  to,  424 
Wounds  by  modern  projectiles,  13 

infection  of,  14 

character  of,  14 

Yam  as  food,  360 
Yaws,  103 
Yellow  fever.  73 

etiology  of,  73 

historical  appendix,  76 

prophylaxis  of,  74 

quarantine  regulation  in,  778 


